Hatchmoor Nursing Home is registered to provide accommodation for 64 people who require nursing and personal care. People reside over two floors, split into eight named units. The ground floor units are specifically for people living with dementia. People with nursing care needs were accommodated on the first floor. There were 57 people using the service at the time of this inspection.

This was a comprehensive inspection carried out on 18 and 20 September 2017. It was unannounced on the first day and announced on the second. At the last inspection in January 2015 the service was rated Good in all five domains. At this inspection we found the service remained Good.

Why the service is rated Good.

People who used the service were safe as the provider managed the risks to their safety and provided staff with training and support to recognise and act on any potential abuse. Comments from people using the service included, “I have safe care and like being here” and “Very safe here. No problem.” People were supported with sufficient numbers of staff and felt their needs were met. Recruitment procedures had been followed to reduce the risks of employing staff unsuitable for the role. Medicines were managed safely however we have made a recommendation to ensure best practice.

Staff received appropriate training for their roles, and had support with supervision from the management team. People’s right to make decisions about their care was respected and those people, who lacked capacity to make their own decisions, had been appropriately supported under the principles of the Mental Capacity Act 2005.

People were supported to maintain a healthy diet and fluid intake and staff were aware of peoples’ dietary needs and preferences. People had access to health professionals to promote their health and well-being.

People were treated with dignity and respect by staff who demonstrated a caring, kind and compassionate approach. Staff understood the needs of people and people and their relatives were involved in the planning of care and support. A variety of opportunities were provided for people to enable them to enjoy meaningful social interaction and reduce potential risks of social isolation.

The service had an open and inclusive culture and people, their relatives and staff were positive about the way it was managed. The provider and registered manager had established quality assurance systems and regular audits were being completed. Issues identified were addressed in a timely manner. People’s feedback was sought in order to improve the service.

We inspected the home on 9 October 2013 and spoke with six people living in the home, three visitors, 11 staff, 2 activities workers, the provider and manager. Some people were unable to comment directly on their care so we spent time with three of them to help us understand what life was like at the home.

People told us they were encouraged to express their views and were involved in making decisions about their care and treatment. They told us “They always ask me what clothes would you like to wear and what would you like to do today?” and “I could not wish for anywhere better”. Visitors said “The staff know exactly what she likes to eat and give it to her, living here has given her a new lease of life”.

Care and treatment was planned and delivered in a safe way for example at mealtimes, people needing it had constant support. People told us they felt safe and well cared for with comments like “They’re always very careful because they’re responsible if something happened to me”. We saw people were moved safely and equipment in the home was well maintained.

Hatchmoor was described by people as being well managed. People were asked for their feedback and confident that if they did have any complaint it would be listened to and acted upon.

The provider was compliant with all outcomes we looked at.

We brought the scheduled inspection forward because we received concerning information about the health and welfare of people at the home. This information suggested that a person’s health needs had not been managed appropriately. We found that the service was compliant with all the standards we looked at.

We carried out an unannounced inspection of Hatchmoor Nursing Home on 5 October 2012. We focussed on the outcomes for people with regard to health and welfare, working in partnership with other professionals, staffing support and competency of care workers and quality assurance.

We looked at the records of four people in detail and spoke with three people about their experiences at the service. There were some people who were not able to comment directly on their care so we spent time with some of them to help us understand what life was like at the home. This meant we spent time observing another four people’s care and interactions with staff to see whether they had positive experiences. To do this we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us about their experiences of care. We used SOFI for one and half hours in the lounge and dining room. At our visit we spoke with five staff, two relatives, three professionals supporting people living in the home, the manager and provider.

People told us that they were involved in all aspects of their care and treatment. For example, we were told “They keep me very clean” and “Are always very kind and caring”. We saw that health care professionals worked closely with the home to ensure people’s health was maintained.

People said that they felt safe and well cared for. For example, one person told us they were looked after by “Brilliant people, who are so nice and very attentive. They treat you like a human being”. We also saw this happening when we observed people’s experiences. We saw that people were regularly prompted with their personal hygiene needs and their dignity was promoted.

We saw that people were occupied with activities and this had a positive effect on their wellbeing. Relatives also remarked about activities, telling us “There’s activities in the lounge every day, outings and other things people can do it they don’t want to join in the group”.

People told us they had confidence in the number of staff, their skills and experience. For example, “They’re always checking on me and come quickly if I call”. Another person told us that some of the staff had been given specialist training from another healthcare professional so that they could meet their needs.

People said that Hatchmoor was “A good place to be, which is peaceful and calm” and “I can’t fault it”. Two relatives told us that communication was “Very good” and that they were “Always reassured by what I see XXX doing, XXX has improved so much since being here”.

At this inspection, we made no compliance actions.

A responsive review of Hatchmoor was completed on 5 July 2011. This was in response to safeguarding alerts relating to

• how pressure area care is managed

• how well the nursing home cares for people with complex needs

• how well care instructions about people's needs are communicated within the team in written records and verbal handovers.

CQC received an action plan from the registered providers about how they intended to comply with regulations, and we continued to be part of the multi agency strategy meeting which is now drawing to a close.

We carried out a further unannounced inspection at Hatchmoor on 6 January 2012 to check on compliance of outcome four- care and welfare of people who use the service. We wanted to check whether the service was following their action plan to meet the regulation in this outcome. We also looked at how well the service was reviewing this aspect of care and welfare so have included outcome 16 in this review- assessing and monitoring the quality of service provision.

We looked at four care plans in detail including electronic and paper copies of information relating to their care and welfare. We also looked at handover information used each shift to pass on details about care needs for people.

We spoke with five people currently living at the service, two of whom were people whose records we looked at. Overall comments from people we spoke with was very positive and included, ‘’They look after my xx downstairs in the dementia unit. (They) can be very trying but the staff do a great job and xx is very well cared for.’’ Another person told us ‘’ You could not want for better.’’

We observed care and support for short periods of time and spoke with three members of staff. We saw that staff interacted well with people and that care and support was delivered promptly and in a kind and respectful manner.

We saw that there had been a change to the electronic system since our last visit. The plans of care did not automatically generate with tick boxes. The system had been changed so that staff had to include detail for each care plan and this allowed it to be more person centred. We saw also that daily electronic records could be linked to care plans so these notes could be sued to review care plan on an ongoing basis. This means that plans were more person centred.

We saw that plans had been reviewed at least monthly and that wound care plans were in place for each person that required one including a body map and a wound care treatment plan which includes a valuation of care. At the time of this inspection there was no one with any pressure ulcer damage of any significance, but we saw that potential to develop ulcers was being monitored well and actively managed with appropriate treatment. We saw that pressure relieving equipment was in place for people who had been assessed as high risk of developing pressure care areas. For people who were less mobile or able to turn or move their position without assistance, we saw that records were in place to record number and times of repositioning. This was also in the electronic records as part of their overall care plan.

We looked at the pre admission assessment information of two newer people to the service and saw that these had been completed in a way that would allow assessed needs to be planned for.

The registered manager told us that since the last inspection they have lost some of their longstanding nurses and care staff, but have been able to employ new staff to these positions. The manager agreed to forward the training records of staff to demonstrate that they understand their role and the care planning and reviewing system. This had not been received at the time of writing this report, but we will look at this as part of the ongoing monitoring of this service.

We were told by the registered manager that they are now holding monthly meetings with the district nurse team to discuss the needs of any people that are at Hatchmoor who are residential and not nursing needs, as their nursing needs come under the remit of the district nursing team. This initiative appeared to be working well.

We asked for information about how the service was reviewing the quality of care and whether care plans and in particular wound management plans were being reviewed and monitored to ensure consistent care. We have been sent details of monitoring of care plans and actions taken to improve care plan development and review. We have recommended some improvements to ensure that the service continues to meet this outcome.

We carried out this responsive review in response to an overall multi agency safeguarding strategy which is being coordinated by Devon County Council. The alert focuses on key themes, which include:

• how pressure area care is managed

• how well the nursing home cares for people with complex needs

• how well care instructions about people’s needs are communicated within the team in written records and verbal handovers.

We carried out a responsive review with an inspection to Hatchmoor Nursing Home on 5 July 2011 and because of the concerns we looked at outcome 4.

We were not investigating this alert because this is being looked at as part of the safeguarding process. The purpose of this review was to check compliance in these two key outcome groups for people currently living in the home.

We looked at the records of 2 people in detail; and where possible we spoke to the individual and or their carer. We observed other people being attended to whilst we were visiting. We also spoke to different care workers including nurses, care assistants and a visiting community nurse.

People we spoke to said that their needs were being met, but we have identified some key areas of concern where lack of assessment and care planning could place people at risk. Essentially this is around pressure damage and wound care. We did not find that outcomes for people were poor, but we did find that wound care plans were not being reviewed and monitored sufficiently to ensure appropriate treatment was consistent. We have set a compliance action in respect of this and we will be reviewing this again in the near future with a further unannounced visit to the nursing home.

The inspection visits took place on 5 and 7 January 2015 and were unannounced.

Hatchmoor Nursing Home is registered to provide accommodation for 64 people who require nursing and personal care. People reside over two floors, split into eight named units. There were 58 people using the service at the time of our inspection.

At the last inspection on 6 and 8 August 2014, we asked the provider to take action to make improvements toward more robust recruitment, ensure care plans included considerations of the Mental Capacity Act (2005) and Deprivation of Liberty (DoLS) Safeguards and to ensure records were complete. We found at this inspection those improvements had been made.

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.

People were supported and cared for by sufficient staff to ensure their individual needs were met with patience and humanity. The staffing arrangements were flexible and where additional staff were required this was provided. Staff training needs were well met and staff were supported and supervised in the work they did. Recruitment was robust and so protected people from staff who might be unsuitable to work with them.

Staff understood how to protect people from abuse and the home had acted to protect people where they believed abuse or harm might have occurred. Examples included staff reporting poor practice and the registered provider reporting possible abuse from a source external to the home. Each person had risks to their wellbeing assessed and steps were taken to mitigate any known risk, such as falls or skin damage from pressure.

The home was a safe environment as maintenance of the premises and servicing of equipment was well managed. Medicines were managed in a safe way and in accordance with people’s individual needs, for example, taking time to encourage a person to take their prescribed medicines.

People’s care and treatment needs were met. One person said, “That is amazing. That is the first time I’ve seen (my father) walking that well for years. That’s real care.” Toward achieving this, the home had good links with local health and social care agencies, such as a local hospice. Nursing staff were able to identify and have training needs met so they could maintain high standards of clinical practice.

People were fully involved in decisions about their care and the staff understood legal requirements to make sure people’s rights were protected.

There were many ways in which people’s views were sought and the home was responsive to their requests, such as menu and activity choices. A person said, “Everyone gets to give an opinion.” There was a very broad programme of ‘Core Activities’:creative, cultural, esteem, emotional and intellectual, based on an individual’s personal history; their strengths and preferences.

People had a nutritious and balanced diet available to them. Where they had specific dietary needs or preferences these were met where possible. Concerns about people’s dietary intake were responded to appropriately.

People were cared for with kindness, patience and respect. People’s preferences were known and provided for. There were many examples of staff knowing when to provide reassurance and taking time to ensure they felt cared for and valued. People’s dignity was promoted: people, their families and staff had been involved in a dignity project.

The home was well led. The goals and objectives of the home were well met. There was a strong ethos of caring and respect for people and staff. Systems used to monitor the service, the approach to staff training, and local health care connections, ensured high standards were maintained and people’s wellbeing was promoted. It was a relaxed, friendly and welcoming place.