We inspected Hampden House on 9 and 12 October 2017. The inspection was unannounced on the first day and we told the provider we would be visiting on the second day.

At the last inspection in August 2016 we found the provider had breached three regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe delivery of care and treatment, staffing levels and governance of the service. An action plan was submitted following the inspection which detailed measures the provider intended to take to improve. At this inspection we found improvements had been made and the provider was no longer in breach of any regulations.

Hampden house is a purpose built property. The service provides care for up to 66 older people and is accommodation for people who require personal care and/ or nursing care. There are three nursing units and three residential units within the service. On the first day of our inspection 50 people were living at Hampden house.

A registered manager was in post. 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.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

Risks to people’s safety had been assessed by staff and recorded in people’s care plans. This enabled staff to have the guidance they needed to help people to remain safe. Further development of the tools used to assess risk in areas such as falls and behaviours that challenged the service were being implemented. There was a system to ensure that where accidents had occurred lessons were learnt and care plans or risk assessments were reviewed. We found this system was not always completed. Following the inspection the registered manager advised us the process was now being implemented.

Staff told us they felt supported by the management team and we saw evidence they had received one to one supervision meetings, appraisals and group meetings in the past year. The level of training staff had received had improved since the last inspection and the registered manager was ensuring staff completed refresher training.

We found there was enough staff to meet people’s needs. Permanent staff had been recruited following safe recruitment procedures and the registered manager was working with the agency who supplied agency workers to provide robust information about those workers who attended. The management team monitored staff response times when people pressed their call bells for assistance and investigated any response times which were not acceptable.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards. They were working within the law to support people who may lack capacity to make their own decisions. Where staff had made decisions in people’s ‘Best Interests’ they had not formally recorded these. A new format of paperwork was introduced following the inspection to ensure this was completed.

Appropriate systems were in place for the management of medicines so people received their medicines safely.

There were positive interactions between people and staff. We saw staff treated people with dignity and respect. Staff showed they knew people very well and could anticipate their needs. People told us they were happy and felt very well cared for. Care plans contained information about people’s likes, dislikes and preferences to ensure people received support how they wanted.

We saw people were

This inspection took place over two days on 30 August and 14 September 2016. The first day of the inspection was unannounced. We gave notice of our visit on the second day of the inspection so that the manager and other key personnel would be available to speak with us.

At our last inspection on 25 and 30 September 2014 the provider was meeting all the regulations that were assessed.

Hampden House is registered to provide nursing care to a maximum of 66 older people. Accommodation in the main part of the building is provided in three nursing and two residential wings set out over two floors. A link corridor on the first floor provides access to further residential accommodation for another nine people located in the adjacent building. On the first day of our inspection 61 people were living at Hampden House.

When we visited there was a new manager in post. The manager was registered as a ‘registered manager’ by the Care Quality Commission on 12 October 2016. 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 this inspection we found management systems and processes were not effective. We identified a breach of Regulation 18 of the Care Quality Commission Regulations 2009 because incidents and events had not always been notified as required to the Care Quality Commission.

Where risks had been identified staff had not always followed the agreed action, to reduce the identified risk. Medicines management was inconsistent increasing the likelihood of errors. Protocols for the use of medicines used on as ‘as required’ basis were not in place and people had not always received their prescribed medicines in a timely way. People’s care records did not always reflect people's health and care needs accurately. All of these matters placed people at potential risk of receiving inconsistent or unsafe care.

We found that there were not always enough care staff to respond quickly to people who needed assistance. Some people living in the residential part of the service required two people to attend to their personal care needs. This impacted the time staff had available to provide appropriate supervision and support for other people in a timely way.

Staff told us they felt they received the training they required. However training records showed significant gaps in training. Systems were in place to ensure staff received regular supervision and appraisals and staff told us this aspect was improving under the new management.

Good recruitment procedures were followed which made sure checks including checks for the nursing staff with the Nursing and Midwifery Council (NMC) had been completed before new staff started work.

Appropriate arrangements were in place to respond to safeguarding incidents.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act (MCA). However, records on MCA and DoLS were not well maintained. Information we received from staff suggested that they were not routinely using capacity assessments in their day to day decision making. We have made a recommendation to improve staff learning and understanding of the MCA.

People spoke positively about staff kindness and patience. We saw people had access to healthcare professionals such as GPs and district nurses. People told us they were treated with respect and this was confirmed in our observations. There was a relaxed and friendly atmosphere and we saw staff were attentive at the mealtime we observed. We saw mealtimes were a pleasant and sociable occasion with people being offered a choice of meals and drinks.

People could follow their own interests and pursuits. A range of acti

We used a number of different methods to help us understand the experiences of people using the service including talking to people who lived at the service, staff, visiting relatives and observing the care provided. We spent time with people using the service and we observed staff being friendly and warm towards people.

We found that people were included in decisions about how their care was provided and their preferences and wishes respected. One person told us "I am consulted about how I want things done, I like to go to my room after tea and staff help me with this."

We spoke with five people who used the service and four visiting relatives; all expressed satisfaction with the care and support provided. One person said "I love it here." Another person said "I am very happy with the care I get, the staff are very kind." Relatives said “It is brilliant, they really care for my Mum. They even help her with her hair and make-up.” And “I can trust the staff to look after my relative. I can’t fault them.”

We saw that medicines were kept safely and that appropriate arrangements were in place in relation to the recording and administration of medicines.

There were sufficient staff available. We saw people being assisted promptly and we saw that staff had time to spend socialising and engaging with people.

The provider had effective system in place to regularly assess and monitor the quality of service that people received.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because the inspection was part of an inspection programme to assess whether older people living in care homes are treated with dignity and respect and their nutritional needs are met.

The inspection team was led by a CQC inspector, and joined by an ‘expert by experience‘ and a healthcare professional. These are people who have experience of using services and can provide that perspective and professional advise.

People told us that they liked living at the home and staff were very kind. They said staff always knocked on doors and hesitated before they went in, they respected their wishes in everything and always asked what people who use the service wanted with regards to their individual care and support needs. They said staff responded quickly to call bells and that they don’t feel rushed when being helped with their care needs. One person said 'Hampden House is like a five star hotel, it is supurb, I want for nothing.'

People we spoke with told us they were very happy at Hampden House. Some told us they first entered the service as respite clients and then decided to stay. They told us they were impressed with the care and support they received from the staff and that they felt very safe and comfortable at the home

One person commented ‘I’m fairly independent, but the staff know what help I need. They sit and talk with me about the care I need, I find them very courteous and polite’. Another said, ‘I’m highly satisfied. The staff have made me feel so welcome and comfortable”.

Others told us “the staff are very caring and remember how you like to be cared for, they listen to what you want.” “Staff genuinely care if you are unhappy with everything and want to put it right”

People also told us how pleased they were about the refurbishment and how good the home now looked.

We returned to the service for a second day on 30 September 2014, to follow up on information we had received on 25 September 2014. The information included concerns about staffing levels, people’s nutritional and personal care needs, faulty hoisting equipment, the colouration of water coming from some bath taps and delays in answering call bells

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Below is the summary of what we found but if you want to see the evidence supporting our summary please read our full report. The summary is based on speaking with people who used the service, the staff supporting them, our observations and from looking at records.

Is the service safe?

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continuously improve.

The service had policies and procedures in place in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS). There was no one currently using the service who had a DOLS in place. The provider knew how to request an assessment if this was required. Staff received safeguarding and Mental Capacity training. This meant people would be safeguarded as required.

When people were identified as being at risk, their care plans showed the actions that would be required to manage these risks. These included the provision of specialist equipment such as pressure relieving mattresses, hoists and walking aids.

There were sufficient care workers to respond to people's health and welfare needs.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in developing their plans of care. People told us they were included in making decisions about how their care and support was provided.

Is the service caring?

We saw staff were attentive and respectful when speaking with or supporting people. People looked well cared for and appeared at ease with staff. The home had a relaxed and comfortable atmosphere.

People were generally positive and complimentary about the care they received. One person said; "I can't speak highly enough of the staff. I have never heard a nasty word said." Another person told us the staff were "fine." Someone told us that he had experience of another residential placement, and said; "This one is absolutely first-class. Staff are very, very helpful. Really kind."

Is the service responsive?

The communal areas were thoughtfully set out to provide spaces for chatting or reading without interruption by the larger group activities or vice versa. The activity co-ordinator was described as "brilliant." Activities were outlined in a weekly bulletin and it was apparent that these were responsive to people’s needs and preferences.

People we spoke with knew how to make a complaint if they were unhappy. We saw evidence that the service welcomed complaints and feedback about the service. We saw evidence where complaints and improvements had been made as a result of this.

Is the service well led?

Some people we spoke with said that sometimes it took a while for staff to attend when they rang the call bell. One person said they were not always confident that staff would return when they said they would come back later. A recent "residents and relatives" meeting had identified actions that had been taken to resolve staffing and call response times. We were also told that this issue was continuing to be audited.

People and their relatives all expressed confidence in the manager at resolving their complaints and issues.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance systems in place. This helped to ensure that people received a good quality service. They told us the manager was supportive and promoted positive team working.