This responsive focussed inspection took place on 11 July 2018. It was completed in response to a number of safeguarding alerts which indicated that people’s needs may not be met in terms of their hydration, nutrition, personal care and safety. We found no evidence to support these concerns during our inspection, however we did find some areas of improvement. These included, an unpleasant and strong odour in the downstairs dining and communal areas, records not being stored confidentially and care records not always reflecting the care and support delivered.

At this focussed inspection we looked at two key questions safe and well-led. No risks,

concerns or significant improvement were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection

When we last inspected this service in July 2017, we found the key area of safe as requires improvement. This was because he upstairs lounges and communal areas had a strong odour. This had been addressed by replacing all the carpet in these areas. We did not issue any requirements.

Hatherleigh care village 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.

Hatherleigh accommodates up to 52 people in one adapted building. At the time of the inspection there was 51 people lioving at the service. It is set over three floors with bedrooms on all three floors and communal lounges, with dining areas on two. The service is in the process of making changes to the way people are accommodated. They are adapting the building into four distinct houses in order to allow they to follow a new model of care, which will mean people will be living in houses according to the stage of their dementia. The service mainly provides care and support for people living with dementia. It also provides nursing care.

Since the last inspection, the service has had a new 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.

At this inspection we found people were appropriately dressed, looked for the most part well groomed. We identified one person who looked unkempt. We spoke with staff and checked their care records. This showed staff had attempted to assist them with personal care but they had refused all help and appeared resistive to any interventions other than being assisted to eat their meal.

People were being assisted to eat and drink sufficiently to keep they healthy. It was a hot day when we visited and staff were offering people hot and colds drinks throughout the day. The lunchtime meal experience would benefit from improvements. There were no condiments on the tables and no menu for people to be able to make choices. Everyone we saw being served appeared to have the same meal. No choices were being offered. The cook said there was always a main meal and a vegetarian option.

We observed the nurse administering medicines being constantly interrupted by staff to request keys. Following feedback to the provider immediate action was taken to address this. This meant the nurse would not be constantly disturbed but it also meant medicines were only accessible to staff who were administering them.

Some improvements were needed in respect of infection control due to the strong odour in downstairs area and a lack of regular washing of soft toys. People would also benefit from improvements to their me

This inspection took place over two days; 25 and 26 July and was unannounced. This was the first inspection since the service had changed its legal entity and therefore had not previously been rated.At the time of the inspection there were 52 people livng at the service.

Hatherleigh Care village is registered to accommodate up to 53 people with nursing and care needs. They provide care and support to people with nursing needs and those living with dementia. The service is set up over three floors. People with nursing needs are on the ground or first floor and people living with dementia accommodated on the second floor.

The service has 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.’

Hatherleigh Care Village was about to undergo some refurbishments to enable the service to develop a model of care which will divide the service into four houses to cater for different stages of dementia. The provider has developed a care model based on the household model of care

pioneered in the USA by LaVrene Norton, Action Pact and Steve Shields. This will result in the

environment being divided into smaller houses to support small group living. Groups will be determined based on the stage of the dementia of the person living at the home. The provider is implementing this model with the support of specially recruited dementia practitioners. The staff group are currently undergoing training in respect of this new model and refurbishment work is due to begin within the next few months.

During this inspection we found upstairs communal areas had a strong malodour which was unpleasant. We heard from two relatives that this smell was persistent. We also heard from a healthcare professional that when they had visited there was a strong smell in the upstairs area of the service. We fed this back to the registered manager who initially believed this may be due to several people using areas to urinate which had permeated into the fabric of the carpet and furnishings. They later agreed the smell was strong and that despite their cleaning team shampooing and deep cleaning carpets they were unable to get rid of the smell.

We found one of the sluice rooms was not kept locked and one of the bathroom cupboards was left unlocked with some cleaning fluids in it. This presented as a possible risk to people. We were assured by the registered manager that this was an oversight rather than normal practice.She took immediate action to ensure checks wee being made throughout the day to ensure peopkle’s safety.

Prior to the inspection we had received some information of concern about low staffing levels particularly at the weekends. Rotas showed there had been three occasions when due to staff sickness care staffing levels had fallen below the providers preferred numbers to ensure people’s needs could met in a timely way. The provider has said that following this feedback, they have commissioned additional agency staff to cover weekends to ensure there are always sufficient staff on duty even if permanent staff go off sick.

People benefitted from staff who knew their needs and wishes to enable them to provide personalised care and support. This was well planned with detailed care plans and risk assessments. These directed staff how to support people safely and in a way they wished.

Medicines were well managed and people received their medicines on time.

Staff had good training and support to enable them to do their job safely and effectively.

Staff understood how to keep people protected and who to report any concerns to. Recruitment practice was robust and ensured only staff who were fit to work with vulnerable people were employed.

People’s rights