The inspection took place on 24 and 25 July 2017. It was unannounced. At a previous inspection in February 2015 we had found breaches of six regulations and rated the service requires improvement. An inspection in June 2016 found the service was no longer in breach of any regulations, but improvements were still needed in the key areas of safe and responsive. At this inspection further improvements had been made and we could give a rating of good in all areas.

Hampton Lodge (St Basils) is registered to provide accommodation, personal care and nursing care for up to 44 older people. The home caters for people with a variety of nursing and other needs, including people with very complex needs, and people receiving end of life care. At the time of our inspection there were 33 people living at the home..

There was no registered manager in post at the time of this inspection. 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 provider had notified us in March 2017 that the previous registered manager had left. A new manager who intended to register with us had been in post for seven weeks when we inspected. Since the inspection we have received an application to register from them.

The provider had arrangements in place to protect people from risks to their safety and welfare, including the risks of avoidable harm and abuse. Staffing levels were sufficient to support people safely. Recruitment processes were in place to make sure the provider only employed workers who were suitable to work in a care setting. There were arrangements in place to store medicines safely and administer them safely and in accordance with people’s preferences.

Staff received appropriate training and supervision to maintain and develop their skills and knowledge to support people according to their needs. Staff were aware of and put into practice the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. People were supported to eat and drink enough to maintain their health and welfare. People were supported to access healthcare services, such as GPs and specialist nurses.

Care workers had developed caring relationships with people they supported. People were encouraged to take part in decisions about their care and support and their views were listened to. Staff respected people’s independence, privacy, and dignity.

Care and support were based on assessments and plans which took into account people’s abilities, needs and preferences. People were able to take part in leisure activities which reflected their interests. People were kept aware of the provider’s complaints procedure, and complaints were managed in a professional manner.

The home had a calm, welcoming atmosphere. Systems were in place to make sure the service was managed efficiently and to monitor and assess the quality of service provided.

This inspection took place on 21 and 23 June 2016 and was unannounced. The home provides accommodation and care for up to 44 older people, including people living with dementia. There were 42 people living in the home when we visited. Accommodation is provided in two units with people requiring nursing care on the ground floor and people living with dementia on the first floor.

At our last inspection on 23, 26 and 27 February 2015, we found six breaches of regulations. The service was non-compliant with staffing, infection control, staff supervisions, monitoring and meeting the hydration and nutritional needs of people, reviewing people’s care plans and the audit process was not effective. During this inspection we found action had been taken and improvements made.

A registered manager was not in post at the time of our inspection. 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 currently in the process of registering the manager for the home.

We found people’s safety was compromised in some areas. Staff were trained and assessed as competent to support people with medicines. However medicines were not always stored correctly and there was not any clear guidance about applying topical creams. Risks were managed appropriately, however a business continuity plan had been recently reviewed and details were no longer relevant and had not been updated.

Most people’s care plans provided comprehensive information and were reviewed regularly. However, there was some confusion for one person’s records about what stage their thickened fluids should be and people’s skin integrity plans were not always adequate to support people appropriately.

Safe recruitment practices were followed and appropriate checks were undertaken, which helped make sure only suitable staff were employed to care for people. Staff received training in safeguarding adults and knew how to report concerns.

Staff received regular one to one sessions of supervision to discuss areas of development. They completed a wide range of training and felt it supported them in their job role. New staff completed an appropriate induction programme.

People received varied meals including a choice of fresh food and drinks. Staff were aware of people’s likes and dislikes and offered alternatives if people did not want the menu choice of the day.

People were supported to eat and drink when needed. People felt they were treated with kindness and said their privacy and dignity was respected. Staff had an understanding of the Mental Capacity Act (MCA) and were clear that people had the right to make their own choices.

People had a choice and access to a wide range of activities. People were able to access healthcare services.

Staff were responsive to people’s needs which were detailed in people’s care plans. People felt listened to and a complaints procedure was in place. Regular audits of the service were carried out to asses and monitor the quality of the service. Staff felt supported by the manager and the area manager and quality business manager were supporting the home and staff.

We carried out a follow up inspection to check on the actions that the provider had taken following an inspection on 18 and 22 April 2013. We looked at the arrangements and procedures the provider had in place to ensure medicines were managed safely.

We found effective arrangements were in place to manage people’s medicines. Staff had completed training in medicines management and they told us the new system for managing people's medicines had improved.

We spoke with twelve people living at the home, a visiting healthcare professional, three visitors and a relative. To help us to understand the experiences of people, we spent time observing what was going on in the home. We observed how people spent their time, the support they received from staff and whether they had positive outcomes.

We observed two lots of activities that were provided by external people on the day. People said that they enjoyed the activities. People told us that they liked the piano music that was provided regularly. We observed that some people were using the music sheets provided and they enjoyed singing along. Three people said that they liked the “music and songs”

People told us that they were treated with respect when receiving care. Two people said that the staff were “very kind “and they received the help and support they needed. One person told us that they preferred to stay in bed and this was respected. Two relatives told us that they had been involved in their relatives care and had provided information to the staff about their relatives. A relative told us that they visited the home prior to their parent moving into the home and that their relative was very well looked after.

We spoke with people living at the home and a relative. To help us to understand the experiences of people, we spent time observing what was going on in the home. We observed how people spent their time, the support they received from staff and whether they had positive outcomes.

We observed interactions between the staff and people who use the service. People told us that they were treated with respect and that the staff were’ very kind.’ A relative told us that they were very happy with the care that their parent was receiving. We were told that the family were given information and they had visited the home prior to their relative moving into the service.

People told us that the staff came round and helped them choose from the menu. They told us that the food was very nice and they were offered a choice. They also told us that the staff were courteous and they felt that their privacy was always respected when receiving care. They said that they were offered choices and there was no restriction to the time when they got up or went to bed. People commented that the staff helped them and ‘it was a lovely place to live.’

People told us that they were supported to bring in items of personal belongings, which included some small items of furniture. They said it was very nice to be able to do this, as it made them feel at home with their belongings around them.

This inspection took place on 23, 26 and 27 February 2015 and was unannounced. The service provides accommodation and care for up to 44 older people, including people living with dementia and mental health illness. There were 41 people living at the service when we visited. Accommodation is provided in two units with people requiring nursing care living on the ground floor. People living with dementia are accommodated on the first floor.

There was a registered manager who was responsible for the care of people. 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.

Prescribed creams and ointments were not managed safely putting people at risk of receiving creams which may have expired. There was a robust process which staff followed for disposal of medicines. Other medicines were managed and stored appropriately.

People were not protected against the risks associated with malnutrition due to a lack of assessments and action plan to manage such risks.

Care plans and assessments were not regularly reviewed including where people’s needs had changed. People were at risk of receiving inappropriate care as care plans did not contain up to date information to reflect people’s needs.

People were put at risk to their health through poor infection control processes. Staff did not follow the guidance on the prevention and control of infections and the associated risk of cross infection.

Staff did not receive support in the form of an organised programme of supervision and appraisal which conformed to the provider’s own procedures. Staff’s practices were not monitored in order to identify training and development needs.

There were not always adequate numbers of staff to meet the assessed needs of people safely and consistently.

The system for monitoring the quality of service provision and regular audits was not robust. This did not identify the issues we found with care planning, risk assessments, infection control and records.

There was a process that the staff followed if people needed to be deprived of their liberty. However the care plans did not all contain information about people’s ability to make decisions and whether assessments were done for particular decisions as needed as part of mental capacity act 2005.

People were satisfied with the food choices offered and the quality of the meals served. Where people had specific needs or preferences these were taken into account and staff were aware of them.

Recruitment procedures were followed and all necessary checks were completed prior to staff commencing work to minimise risk to people.

There were procedures for responding to complaints which were followed. A complaint log was maintained for recording complaints which included details of investigations and feedback to complainants.

We have made a recommendation about medicines management for the provider to consider when providing care to people.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This corresponds to breaches 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