This inspection took place on 27 January 2017 and was unannounced.

At our last inspection on 14 December 2015 we rated the service as ‘Requires Improvement’. There were two breaches of regulation and three recommendations within the report.

Hambleton Court Care Home provides accommodation and personal care for up to 18 older people. The service is provided over two floors and is a converted house located in the village of Hambleton near Selby. There is car parking available to the front of the service and disabled access into the building. People have access to a large garden area to the rear of the building and enjoy a selection of communal spaces within the service. These included two dining areas, a large lounge and a smaller sun room. Both floors of the service have communal bathrooms and toilet facilities. The bedrooms are all single occupancy and twelve bedrooms have a toilet and wash-hand basin en-suite facility.

The registered provider is required to have a registered manager in post and there was a registered manager at this service. 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.

The registered manager monitored accidents within the service to ensure people were kept safe. However, they had not completed an analysis of these to identify any trends or problems within the service. There was a lack of information and evidence to show that feedback from staff, people and relatives was analysed, responded to and used to make improvements. We have made a recommendation about this in the report.

People told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and staff had been employed following robust recruitment and selection processes. Medicines were administered safely by staff and the arrangements for ordering, storage, administration and recording were robust.

Improvements had been made to how the service applied the principles of the Mental Capacity Act 2005. People gave consent to their care and their opinions and viewpoints were listened to and acted on.

People’s nutritional needs had been assessed and they told us they were satisfied with the meals provided by the home.

People spoken with said staff were caring and they were happy with the care they received. They had access to community facilities and most participated in the activities provided in the service.

Improvements had been made to the quality of the care plans. These had been rewritten and reflected person-centred care needs, which had been discussed and agreed with people and their families. We saw that the care being given reflected that which was recorded in the care plans.

People knew how to make a complaint and those who spoke with us were happy with the way any issues they had raised had been dealt with. People had access to complaints forms if needed and the registered provider had investigated and responded to the one complaint that had been received in the past year.

This inspection took place on 14 December 2015 and was unannounced.

At the last inspection on 14 May 2014, the service was not meeting Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 medicines which corresponds to Regulation 12 (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) 2014 Safe care and treatment and Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 record keeping which corresponds to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 Good governance. We also recommended the service review their implementation of the Mental Capacity Act (2005). A follow up inspection took place on 14 August 2014 and the service was found to be meeting the regulations.

Hambleton Court Care Home provides residential care for up to 18 older people. The service is a converted house, which has been extended, the service is provided over two floors and there is a passenger lift. The majority of rooms are en-suite. It is located in the village of Hambleton near Selby. There is a car park to the front and a large secure garden at the rear of the property.

At the time of our inspection there were 17 people living there.

The service had a 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 service was not consistently applying the principles of the Mental Capacity Act (2005), although we saw staff routinely sought consent, there was some information within people’s care plans which suggested they may not be able to make an informed decision with regard to their care and treatment. We did not see mental capacity assessments or best interest decisions recorded in these instances. Some people were subject to constant supervision without the necessary safeguards in place. This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Although people told us they received a good standard of care we saw some care which was not delivered in line with the person’s care plan. We saw some out of date information in care plans. We did not see involvement of the person and their families in the development and review of care plans. This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

People were protected from harm, the registered manager and care staff knew how to recognise abuse and what action to take if they suspected it. Risks assessments and risk management plans were in place to support people to remain safe. People were supported to take their medicines safely.

There were times of the day when there were only two members of care staff on duty they undertook other roles in addition to this. Although no one we spoke with told us this had an impact on the care and support they received we were concerned because one person needed care from two care staff, and three people needed supervision to ensure they were safe. We have made a recommendation in relation to staffing levels.

The service was clean and well decorated, bedrooms were personalised and we found the service to be ‘homely’.

Staff told us they felt well supported by the registered manager and they had access to a variety of training. However, staff did not receive regular formal supervision and they had not had a recent appraisal. We have made a recommendation in relation to supporting staff.

People told us the food was good. The service sought support from relevant health care professionals when required.

Staff knew people well and we saw care was kind, compassionate and dignified. People told us they felt well cared for.

There was a range of activities available to people. Everyone we spoke with knew how to make a complaint, and the service displayed the complaints policy so people and visitors could see it. The registered manager told us they had an open door approach and had not received any formal complaints since our last inspection.

The registered manager was ‘hands on’ in their role and people knew them well. However, there was room for improvement across the service. The registered manager needed time to commit to this and to develop formal systems and structures to ensure they delivered safe, effective and responsive care. We have made a recommendation in relation to formal quality audits to be introduced as well as updates to the service’s policies and procedures.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well-led? We also wanted to check that the provider had taken action to improve two areas that we found none compliant at our last inspection of this service.

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

Is the service safe?

The home had safe systems in place to ensure people received their medication as prescribed; this included regular auditing by the home and the dispensing pharmacist. Staff were assessed for competency prior to administering medication and this was re assessed regularly.

Records required to protect people against the risk of unsafe or inappropriate care and treatment were up to date and reflected an accurate record of each person's needs.

Policies and procedures for the safe running of the service were fit for purpose and accessible to staff to support their role and responsibilities.

Is the service effective?

n/a

Is the service caring?

n/a

Is the service responsive?

n/a

Is the service well led?

n/a

During our inspection we asked the provider, staff and people who used the service

specific 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. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, and the staff who supported them and from looking at records.

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

Is the service safe?

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. However, further training for staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards would ensure the provider had the knowledge and skills to act in accordance with legal requirements to safeguard people.

Some aspects of the systems in place for people to receive their medication were not always safe. Staff had received training prior to administering medication but a practical competence test had not been carried out or completed as part of a periodic review of competence.

There were sufficient staff available on duty to meet the needs of people.

Records required for the safe and effective running of the service were not kept up to date or accurate. This placed people at increased risk of receiving inappropriate and unsafe care.

Is the service effective?

People's health and care needs were assessed with them. People told us they were included indecisions about how their care and support was provided.

Staff received regular training relevant to their role. This helped ensure the staff team had a good balance of skills, knowledge and experience to meet the needs of people who used the service.

Is the service caring?

Without exception people said they were very satisfied with the care and support they received. They said staff were attentive and “nothing was too much trouble” and “staff here go the extra mile for you; we are very well care for.” Another person said “staff are wonderful and attend to my every need.” Care and support was provided in accordance with people's wishes.

We saw that staff acted in a kind and respectful way People looked well cared for and appeared at ease with staff. The home had a relaxed and comfortable atmosphere. We saw staff crouching down to talk to people at eye level and speak at a pace that was comfortable for the person.

Is the service responsive?

People’s needs were met in accordance with people’s wishes.

The manager made sure they spoke with people and responded to requests and concerns. For example in facilitating specialist equipment to ensure someone could continue to go out in the car.

People we spoke with knew how to make a complaint if they were unhappy and felt confident they would be listened and responded to.

Is the service well-led?

The manager completed a daily walk around of the home to check on the environment and to speak to every person who used the service. They spoke with people about their satisfaction and took action to rectify any concerns.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home. They told us the manager was supportive and promoted positive team working.