About the service: Hamshaw Court is a care home. People in care homes receive accommodation and nursing or 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. Hamshaw Court provided personal care to 33 adults at the time of the inspection in one adapted building. Some of these may have been living with dementia.

People’s experience of using this service: People continued to experience unsafe administration of their medicines.

People did not always have their rights protected regarding when they lacked capacity to make decisions. People were not supported to have maximum choice and control of their lives and staff did not support this practice.

People and relatives continued to experience unsuitable management of their complaints.

The provider’s governance systems were ineffective and lessons were not always learnt when things went wrong. At times details were missing from support plans and staff did not carry out what was written down. Staff responsibilities were not clear and so support to people was sometimes missed. These and other shortfalls were not always picked up on audits.

The provider did not consistently carry out supervision and appraisal for staff, which meant people’s care was not always well directed. We made a recommendation about this.

People were not always monitored regarding a healthy intake of food and fluid or given their meals as advised by dieticians and speech and language therapists. We made a recommendation about this.

Systems used to safeguard people from abuse showed there was some improvement with a reduction in accidents, but further improvement was needed, as allegations of abuse were still higher than would be expected from a service of this size.

Risks that people faced were safely managed. Staffing numbers were safe and recruitment procedures were robust. Safe infection control measures were practiced in the service.

The registered manager and staff worked well with other agencies. The premises were suitable for older people and those living with dementia. People were well supported with their healthcare.

People expressed their views and also had effective opportunities to make these known on how the service was run. The provider respected their privacy, dignity and independence. People were supported at the end of their lives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Requires Improvement. This service has been rated requires improvement at the last two inspections. (The last report was published 09 March 2018.)

Why we inspected: This was a planned inspection based on the previous rating.

We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 around safe care and treatment, need for consent, receiving and acting on complaints and good governance. Details of action we have asked the provider to take can be found at the end of this report.

Follow up: We shall be asking the provider to meet with us to discuss the continued rating and to look at their action plan for improvement. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection of Hamshaw Court took place on 27 and 30 November 2017 and was unannounced on the first day but announced on the second.

Hamshaw Court is a residential care home for up to 45 older people who may be living with dementia and is located down a residential street in Kingston-Upon-Hull. Accommodation is provided in individual flat-lets, each of which has its own bedroom/sitting area, a small kitchenette and an en-suite shower room. Some of the kitchenettes have been altered so that they are no longer functional to prepare or heat up meals, but still offer storage. There are communal rooms to sit in and an enclosed garden. At the time of our inspection there were 39 people using the service.

The provider was required to have a registered manager in post. 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.

At the time of the inspection there was a manager that had been registered for the last two years and eight months. However, the registered manager had taken another post and held a second registered manager's certificate without cancelling their registration at Hamshaw Court. They held two separate manager registrations for two different locations belonging to two different providers. They had returned to Hamshaw Court when their new position had not worked out.

At the last comprehensive inspection in September 2016 the service was in breach of Regulations 9, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At that inspection the service was rated ‘Requires Improvement’. These breaches in regulations were with regard to safe care and treatment, person-centred care and good governance.

The provider put people at risk of harm because staff practice and recording were not in line with how medicines were prescribed and had to be accounted for. Audits used by the registered manager had not identified issues with the safety of the environment, care plans or medicines. The provider had not ensured care plans were up-to-date with regard to managing anxieties, catheter care, pressure care, weighing people and personal hygiene. Therefore people could not be sure they accurately instructed staff on how to meet their needs. We issued two requirement notices and a warning notice to the provider.

At that inspection we asked the provider to take action and make improvements to the recording and practice when administering medicines, the effectiveness of identifying shortfalls with the environment, medicines and care plans when auditing them and with care plan reviews so that people received accurate care and support. The provider sent us an action plan saying when these improvements would be made to comply with the warning notice.

We visited again on 08 February 2017 to assess whether or not the warning notice we issued had been met and found that it had. We found sufficient improvement had been made to ensure the provider met the regulation, as audits had been set up and were being used to identify shortfalls with the environment, care plans and medicines. Action was being taken swiftly to remedy the shortfalls identified.

At this inspection in November 2017 we checked whether the requirement notices were addressed and if the provider was now meeting regulations. We found that they were not. Therefore the service was still rated as 'Requires Improvement'. This is the second consecutive time that the service has been rated as 'Requires Improvement'. There were still issues with the safe management of medicines in regard to recording. People’s medicines were not always safely managed, because recording and practice were still poor. This was a continued breach o

Hamshaw Court is registered with the Care Quality Commission (CQC) to provide care and accommodation for a maximum of 45 older people some of whom may be living with dementia. It is close to local amenities and is located on a bus route into Hull city centre. Accommodation is provided in individual flat-lets, each of which has a bedroom/sitting area, some have a small kitchenette and an all have an en-suite shower room. There are communal rooms for people to use and an enclosed garden.

This inspection took place on 8 February and was unannounced. The service was last inspected 28 and 29 September 2016 and was found to be none complaint with the regulations inspected at that time. Following that inspection we issued a warning notice to the registered provider to improve governance. This inspection was undertaken to check whether they had complied with the actions we told them to take in the warning notice.

There was a registered manager in post. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection we found issues with the way people’s medicines were handled, the environment and people’s care plans. We issued requirement notices for these breaches of regulations and these will be checked again at the next inspection.

During the previous inspection we found auditing systems in place had not identified those issues we found during the inspection. We also found some audits had identified issues with care planning but despite this no further checks had been undertaken to ensure these issues had been rectified, for this breach we issued a warning notice which told the registered provider to take action within a given time frame.

During this inspecting we found the registered provider had taken action to comply with the warning notice. Audits had been undertaken of all the medicines systems and actions had been taken to address any shortfalls, a full audit had also been undertaken by the supplying pharmacists. The medicines system will be looked at in more detail at the next inspection. We found a full environmental audit had been undertaken and there was an ongoing refurbishment programme. An inspection of the building showed us the work had been carried out to a high standard and all rooms looked well maintained and all work had been completed. We found a full audit had been undertaken of all care plans and further checks had been made to ensure any issues found were addressed. We cross referenced a sample of care plans and found updates had been undertaken promptly when any shortfalls had been identified. We will undertake a full inspection of care files again at the next inspection.

Hamshaw Court is registered with the Care Quality Commission (CQC) to provide care and accommodation for a maximum of 45 older people some of whom may be living with dementia. It is close to local amenities and is located on a bus route into Hull city centre. Accommodation is provided in individual flat-lets, each of which has a bedroom/sitting area, a small kitchenette and an en-suite shower room. There are communal rooms for people to use and an enclosed garden.

This inspection took place on 28, 29 September 2016 and was unannounced. The service was last inspected in December 2015 and was found to be non-complaint with regulation 10, 12 and 17 of the Health and Social Care act 2008 (Regulated activities) Regulations 2014. We undertook this inspection to check whether the registered provider had complied with what we had asked them to do following the last inspection.

At the time of the inspection 29 people were living at the service.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During this inspection we identified concerns about the handling of medicines. This could put people at risk of not receiving medicines as prescribed by their GP. The service had recently undergone an extensive refurbishment and this improved the overall appearance of people’s rooms. However, some of the refurbishments had not been finished off properly before people had moved into the rooms and there were lots of jobs that still needed doing. This was discussed with the operations manager and the registered manager and actions were put in place to rectify this. Many of the issues had been resolved before the end of the inspection. We found staff did not always follow good practice with regard to infection control; we have made a recommendation about this.

People’s care plans did not contain enough detail to ensure they received care and attention which met their needs. Care plans lacked clear instructions for staff to follow with regard to supporting people who may find certain situations threatening or frustrating. Documentation regarding people’s care needs had not been updated, for example catheter care, repositioning charts and the use of pressure relieving equipment. People’s weights had not been recorded consistently so assessments could not be made as to any changes in their nutritional and dietary needs. No other recognised good practice methods were used to ascertain people’s weights.

Although audits had been undertaken no time scheduled action plans were in place to address any issues found. Despite audits finding shortfalls in the care planning no follow up action had been taken to make sure any issues found had been rectified, similarly none of the audits undertaken had identified the short falls we found during the inspection.

Staff were able to tell us about the registered provider’s procedures in place to keep people safe from harm and how to report any safeguarding issues they may become aware of. They had received training in this area. Staff had been recruited safely and were provided in enough numbers to meet people’s needs.

People received a wholesome and nutritious diet which was of their choosing. People were offered drinks and snacks throughout the day and snacks were freely available in the main entrance. Staff had received training in how to meet people’s needs and this was updated regularly, they also received support to gain further qualifications and experience. Systems were in place which ensured current legislation was followed which protected people when they needed support to make informed choices and decisions. People who used the service were supported to access health care professionals when n

Hamshaw Court is registered with the Care Quality Commission [CQC] to provide care and accommodation for a maximum of 45 older people, some of whom may be living with dementia. It is close to local amenities and is located on a bus route into Hull city centre. Accommodation is provided in individual flat-lets, each of which has a bedroom/sitting area, a small kitchenette and an en-suite shower room. There are communal rooms for people to use and an enclosed garden.

This inspection took place on 2 and 3 December 2015 and was unannounced. The service was last inspected June 2014 and was found to be compliant with the regulations inspected at that time.

There were 37 people living at the service on the day of our inspection.

At the time of the inspection there was no registered manager in post. The deputy manager had taken on the responsibly until such time as a new manager was recruited, they will be referred to as the acting manager throughout the rest of this report. The area manager told us there had been an appointment made and the new manager was due to take up their post on the 18 December 2015. 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 a 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 provider was found to be in breach of three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Breaches were found with regard to, infection control, dignity and respect and governance. You can see what action we have told the registered provider to take at the end of this report. There were also issues found with the way people’s medicines were administered and handled and staffing levels, we have made recommendations about these.

Staff were not provided in enough numbers to ensure people’s needs were effectively met. Staff had not undertaken essential caring tasks and had not kept essential information about the person’s wellbeing up to date. There had been a number of unwitnessed falls and accidents at the service, which the staff had failed to summon attention for in a timely way. This could have a detrimental impact on people as their welfare might not be maintained and their care needs not met. Systems were not in place to ensure people were not exposed to the risk of cross infection and lived in a well maintained and clean environment. Bedrooms were dirty and carpets needed replacing. En-suite bathrooms and toilets were dirty and the flooring needed replacing. Toiletries were left out in bathrooms and lids had not been replaced on tooth paste and other creams, these were accessible to people who were living with dementia and exposed to the risk of cross infection. Kitchens in the flats were in need of refurbishment and food was not stored in accordance with good practise guidelines. Soiled laundry was not handled in line with good practise guidelines and the equipment was not used appropriately.

Staff used disrespectful, patronising and negative language in the daily reports to describe people’s behaviours. For example, words like ‘attention seeking’ and ‘demanding’ had been used to describe people explaining to staff their preferred choices. We also heard staff talking to people in a demeaning and argumentative manner. This was discussed with the area manager at the time of the inspection to address with the member of staff involved.

Systems had not been maintained which ensured people lived in well run service. Safety audits had not been carried out and consultation had not been undertaken with the people who used the service or others who an interest in people’s wellbeing. Staff meetings had not taken place.

Staff understood they had a responsibility to keep people safe and knew how to report any abuse they may witness. St

The inspection was carried out by one inspector. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• 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 using the service and the staff supporting 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?

During the short observation for inspection (SOFI) we saw people who used the service were treated with dignity and respect by the staff.

Staff had received training in the Mental Capacity Act 2005 and relevant staff had received training on Deprivation of Liberty Safeguards. The acting manager understood when an application would need to be made and how to submit one.

Risk assessments were completed so staff had guidance in how to support people in ways that minimised the risks.

Medicines were managed safely and people received their medicines on time and as prescribed.

There was sufficient staff on duty during the day and night. The number of staff on duty took account of people’s care needs. Staff had received appropriate training in order for them to support people safely and meet their needs.

The service was safe, clean and regular checks of equipment and hygiene were carried out.

The service had policies and procedures to provide staff with guidance about their role and tasks.

Is the service effective?

People were able to make choices about aspects of their lives and could take part in activities inside and outside the service.

People’s health and social care needs were assessed with them and there was input from relatives. Specialist needs in relation to religion, diet, dementia care needs, falls, mobility and equipment were identified and planned for. During the SOFI we observed staff provided people with dementia a visual choice at lunchtime. This made it easier for them to choose what they wanted to eat.

The layout of the environment and individual flat-lets helped people to maintain their independence.

Visitors told us they could see people in private and were made to feel welcome at all times.

Is the service caring?

People were supported by kind and attentive staff. During the SOFI we saw that staff showed encouragement and patience when supporting people. People who used the service told us they enjoyed having a laugh and a joke with staff.

People’s preferences, likes and dislikes had been recorded and care and support was provided in accordance with people’s wishes and choices. Staff demonstrated they knew people’s needs and preferences.

Is the service responsive?

People had access to a range of health and social care professionals such as GPs, district nurses, dieticians, social workers, dentists, opticians and chiropodists. There was evidence the staff team sought appropriate advice, support and guidance during emergency situations.

People were able to complain and we saw these were investigated and addressed. People were able to make suggestions about the service during meetings and these were acted upon.

Is the service well-led?

The acting manager had been overseeing the service for the last few months due to changes in the management structure. Support had been provided by an area manager once or twice a week and a visit from an established manager from another service in the company, once a week. The acting manager told us they felt they had received the support they required during this period.

The service had a quality assurance system that included checks and obtaining people’s views. Records showed us that shortfalls identified during these checks were addressed promptly.

Staff told us they were well supported by the acting manager, senior care workers and the area manager.

What people who used the service, and those that matter to them, said about the care and support they received.

People told us they were treated with dignity and respect. Comments included, “I do like it here but I don’t like joining in the activities”, “The staff knock on doors. I always lock my door but they have a key for emergencies”, “I enjoy time in my flat; I watch TV and play the accordion” and “It’s nice here but not quite like home of course. I don’t think they could make any improvements; they work very hard and are always on the go. They come and have a chat with me.”

People said their health care needs were met. Comments included, “Yes, I do feel the staff look after me; they will get the doctor out when I need him”, “I’ve seen the optician, the dentist and I had a flu jab” and “Yes, I get all my tablets; I have eight in the morning, three to four at tea-time and one at night.”

A relative told us they were very happy with the service. They said, “I looked at lots of other homes and did my research; this was the best one. They keep me informed; mum fell and they rang me.”

People who used the service were complimentary about the staff and said staff spoke to them in a nice way. They said staff answered call bells in a timely way. Comments included, “The staff are very good” and “Yes, they all respect dignity. I like to have a laugh and a joke with them.” A relative said, “The staff are lovely; the way they speak to mum is really nice.”

People were consulted about their care and treatment and where some people found decision making difficult the provider followed legal requirements.

Information was available for staff to follow which ensured people received care which met their needs. There was also information about how to keep people safe. People told us they were happy with the care they received. One person said, “The staff are great, you just can’t fault them” and “I’m quite well looked after and all the girls are very caring.”

We saw that people were provided with a varied and nutritional diet. People told us the food was very good. One person said, “The food is always of a high quality and there’s always plenty of it” and “I like the puddings.”

We saw that the provider had a recruitment process in place which ensured, as far practicable, people who used the service were protected and not exposed to staff who should not be working with vulnerable adults.

People who used the service knew they could complain and who they should complain to. Comments included, “I would talk to the manager”, “Yes I know I can complain but I don’t have any” and “I would see the boss.”

We found that there were enough staff on duty to meet the needs of the people who used the service. The home was warm and quiet and staff were going about their duties in a manner which did not disturb people who were sleeping.

People who used the service told us they could lead a life style of their own choosing. One person said “It’s like a hotel I just come and go as I please.” People knew they had a care plan and told us about attending reviews and meeting about their care. They also told us they were consulted about how the home was run. One person said “Yes, we have residents meetings and we discuss outings, activities and the food.”

People told us the care staff were very kind and caring. One person said “The girls are excellent you just can’t fault them” and “I have a lovely key worker she makes sure I’m safe and well looked after.”

People told us if they had any concerns they would speak to the manager. One person said “My key worker is very good I would speak to her she would sort it out for me.”

A visitor spoken with was confident their relative was safe and they would speak to the manager if they had any concerns.

People were no consulted as part of this review.

One person knew they had a care plan they told us “ I know what is written in my

care plan and the staff have to follow that to make sure I’m ok”.

People told us that they enjoyed the meals comments included “the food is excellent”, “the meals are very good indeed”, “the meals are always well presented and that is important to me”, “there is always a good choice”.

People who live at the home told us they knew who to make a compliant to, comments included “I would go straight to the boss”, “I know she would take me seriously and look out for me”.

People told us that the home was always clean and tidy, comments included “the girls clean my room every day”, “they are always busy cleaning and tidying”, “I like living here and I like my room”, “I like sitting here you see all the comings and goings”.

People told us that they were generally satisfied with the amount of care staff on duty; comments included “the girls are very good and they always see that I’m ok”, “sometimes I have to wait for a long time to go to the toilet”, “they are very kind to me, and I really like my carer”.

People told us that they are consulted about the home, comments included “yes I have my say”, and “I think I once went to a meeting”, “I just tell the manager and she sorts it out”.