Hartley House Care Home provides residential accommodation for up to 57 older people, most of whom have dementia or cognitive impairment. The accommodation is provided on the ground floor, in three units. There were 55 people living in the service at the time of our inspection.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good and met all relevant fundamental standards.

Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced. Appropriate steps had been taken to minimise risks of falls for people.

There was a sufficient number of staff deployed to meet people’s needs. Thorough recruitment procedures were in place to ensure staff were of suitable character to carry out their role.

Staff received essential training, additional training relevant to people’s individual needs, and regular one to one supervision sessions.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effectively with people and treated them with kindness and respect.

People were supported to have choice and their independence was promoted by staff who understood the needs of people living with dementia. Staff supported people in the least restrictive way possible and the policies and systems in the service supported this practice.

The staff provided meals that were in sufficient quantity and met people’s needs and choices. People told us they enjoyed the food. Staff knew about and provided for people’s dietary preferences and restrictions.

People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. These records help staff deliver care that met people’s individual needs. The activities provided were suitable for people living with dementia.

The provider and the management team were open and transparent in their approach. They placed emphasis on continuous improvement of the service.

There was a system of monitoring checks and audits to identify any improvements that needed to be made. The area manager and the registered manager acted on the results of these checks to improve the quality of the service and care.

Further information is in the detailed findings below.

The inspection visit was carried out on 31 December 2014 and was unannounced. The inspection was brought forwards because of concerns raised to the Care Quality Commission (CQC) from an anonymous source, in regards to people’s general care and welfare. We did not find any evidence to support these allegations.

The premises are a modern detached building situated in a residential area of Cranbrook. The service provides general nursing care and accommodation for up to 57 older people, most of whom also have dementia. The accommodation is provided on the ground floor, in four units. Three of these are for older people requiring residential care and who are living with dementia, and the fourth unit is for people requiring residential care. The new premises were opened in December 2013 and included part of the renovated original building and a modern extension. The new lay-out provided accommodation with units that remained connected, so that people could walk to and from any of the units and meet other people. This lay-out reduced the risks of social isolation and promoted independence. On the day of the inspection, there were 52 people living in the home. Most rooms were for single use, but three rooms for shared use were being used as single rooms.

The service is run by a registered manager, who was present on the day of the inspection visit. 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 and associated Regulations about how the service is run.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Many of the people in the home had been assessed as lacking mental capacity to make complex decisions about their care and welfare. There were clear records to show who their representatives were, in order to act on their behalf if complex decisions were needed about their care and treatment. The registered manager had made several applications to the DoLS department to obtain their authorisation for restricting people’s liberty when going out of the home, as they had been assessed as unsafe to go out of the building unaccompanied. Other applications were being prepared.

Staff had been trained in safeguarding adults, and discussions with them confirmed that they understood the different types of abuse, and knew the action to take in the event of any suspicion of abuse. Staff were aware of the service’s whistle-blowing policy, and were confident they could raise any concerns with the registered manager or provider. Two members of staff told us they “Would not hesitate to report any concern straight away”.

The service had suitable arrangements in place to protect people from assessed risks. These included risks of fire; risks of slips and falls; risks with the use of equipment; and risks associated with gaining access to medicines or substances that could be hazardous to people’s health. The service had a system in place for monitoring accidents and incidents, which identified their frequency and location, and showed if any patterns were developing. The registered manager took appropriate action to minimise the possibility of further accidents.

The premises provided a clean, welcoming and odour-free environment. All the bedrooms, bathrooms, shower rooms, communal areas, kitchens and toilets that we saw were cleaned to a good standard. Maintenance records showed that day to day checks and repairs were carried out reliably, ensuring that people lived in a safe environment. The maintenance person told us that he “Walked the building” each month with the provider, to discuss on-going repairs, and plan for other repairs and redecoration of different areas. The lay-out and furnishing of the premises were designed with people’s safety in mind. The corridors were wide and included hand rails to provide areas that were safe for people to walk in. All flooring was non-slip and under-padded to minimise the risk of harm to people when they were walking about. Call bells and equipment were checked, serviced and repaired as necessary.

There were sufficient numbers of staff on duty to meet people’s needs, and include them in social activities of their choice. The registered manager told us she was able to put additional staff on the rotas when needed. The home occasionally used agency staff in times of staff sickness or absence to ensure a full complement of staff was on duty.

The service had robust staff recruitment practices, ensuring that staff were suitable to work with the people living in the home. These included checking prospective employees’ references, and carrying out Disclosure and Barring Service (DBS) checks before successful recruitment was confirmed. (DBS checks identify if prospective staff have had a criminal record or have been barred from working with children or vulnerable people). New staff went through rigorous induction programmes and a probationary period before being employed as permanent staff. The probationary period included carrying out all essential training. The service had systems in place to identify when staff were due to attend refresher courses. Additional training subjects were made available for staff. This included dementia training. Staff were supported through individual supervision meetings, regular training, support with formal training qualifications, staff meetings, and yearly appraisals. Only senior care staff administered medicines, and they had received appropriate training for this. Medicines’ storage and administration was carried out in accordance with the guidelines for safe administration of medicines in care homes.

People’s health needs were monitored, and health professionals such as doctors and district nurses were contacted for support and advice as needed. People’s care plans provided detailed information about their individual medical needs, as well as their previous family and social history, their preferred lifestyles, and their food likes and dislikes.

People said that the food was “Very good” and that they had plenty of choice. If they did not feel like having the items on the menus, they could ask for something different and this would always be given to them if the cook had the necessary ingredients in stock. Some people needed assistance with eating and drinking, and staff took time to help them and did not rush them. Staff showed kindness to people, and displayed thoughtful and caring attitudes. People were asked for their verbal consent before any procedures were carried out (for example, dressings by the district nurse); and were able to go where they wanted and do what they wanted to. The home provided person-centred care, ensuring that people were able to get up and go to bed when they wished; and to have a lie-down during the day if they wanted to. People’s privacy and dignity were respected. Records were well maintained and kept up to date, and were stored so as to protect people’s confidentiality.

People and their relatives told us that if they had any concerns they would talk to the senior staff on duty, or the manager. They were confident that if they raised any concerns that these would be dealt with appropriately. The registered manager had a daily visible presence in the home. People, relatives and staff said that she was approachable and listened to any concerns or comments. The manager carried out on-going daily, weekly and monthly checks to monitor the home’s progress and to address any issues.