Hatt House is a residential care home in Torquay providing care and accommodation to a maximum of 24 people. People living at the home were older people, the majority living with dementia or mental health needs.

People’s experience of using the service

People using the service benefitted from kind, caring staff. People and their relatives told us they were treated with kindness, compassion and respect.

People were placed at the heart of the service and involved in decisions as far as possible. People, their relatives and staff, told us they were listened to and care was individualised.

People’s care was provided safely. The staff team were consistent, staff knew people well and staff supported people to move safely around the service. People’s risks were known and managed well, promoting independence as far as possible. People were protected from discrimination because staff knew how to safeguard people.

People lived in a service which had a positive culture and was led by a dedicated manager. Hatt House had good relationships with local healthcare professionals and the mental health team supporting people’s care.

Rating at last inspection:

At the last inspection the service was rated as Good. (The last report was published 20 October 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. The service remained Good.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned based on the rating. If we receive any concerns we may bring our inspection forward.

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

This inspection took place on the 25 and 31 August and 5 September 2016. The first and third visits were unannounced. The second visit was by appointment. The first inspection visit started at 06.30am, to allow us to meet with the night staff and see how staff duties were organised for the day. The inspection had been bought forward due to concerns we had received about the home. These had related to individual concerns over people’s well-being, including support for people who had distressed behaviours, a lack of person centred care and medicines. We did not find these concerns to be substantiated.

Hatt House provides care and accommodation for up to 24 people. People living at the home were older people, the majority of whom were living with dementia or mental health needs. Some people had significant dementia or distressed behaviours, which meant they needed individual staff allocated to them for periods of time to help maintain their safety and well-being.

The home did not have a registered manager in post. 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. However the provider who had been the previous registered manager was still working at the home and the manager in post was in the process of registering with us.

People received safe care. Their needs were regularly assessed and risks to their health and welfare mitigated and managed wherever possible. Learning took place to reduce the risk of re-occurrences of incidents and accidents, and the environment was well maintained. Infection control practices were well understood, and all areas of the home seen were clean and free from odours. Laundry systems ensured that people’s clothing was looked after, and people were supported to dress and maintain their own standards of personal care.

People were protected from the risks associated with medicines. There were safe systems in place to ensure people received the correct medicine at the correct time. Regular audits were carried out to ensure medicine was available when people needed it, including for people whose needs for medicine might change quickly. We saw people being given information about their medicines and supported to take them.

A full recruitment procedure was followed for new staff and there were enough staff to meet people’s needs. Staff received sufficient training and support to enable them to carry out their role. We saw staff supporting people well in a calm and positive manner, and with affection. Staff respected people’s individuality and spoke to them with respect. They understood how to keep people safe from abuse, and understood how to report any concerns about people’s well being. Systems were in place for the safe management of complaints and concerns.

Care plans identified people’s strengths, such as a sense of humour as well as areas of support needed. Plans were individualised and people were supported flexibly in ways that respected their wishes and preferences, such as for when they liked to get up. Where people needed additional support for example to manage anxiety or risky behaviours staff worked consistently and shared information to ensure they worked with the person in the same way.

We saw time was taken to help people retain the skills they had and to be as independent as possible. Staff had information available to help them understand people’s needs and any healthcare conditions they may have. People received good support from community nursing staff, medical support and other community support agencies. People told us and we saw that emergency medical support had been provided for people when needed.

People’s rights under the Mental Capacity Act 2005 were being respected. Staff understood ab

Prior to this inspection we received information of concern relating to the inappropriate use of reclining chairs to restrain people. We were also told that staff training in relation to fire safety was out of date. Concerns were also raised about people's bedding being old and worn and insufficient mugs for people to drink from.

During the morning of the inspection we spent time talking with the manager, looking at records and we had a tour of the building. We looked in every bedroom.

We saw that two people used recliners chairs. Both were used appropriately and were not being used for restraint.

We looked at staff training records. They showed that staff training in relation to fire safety was out of date. This meant that staff were not suitably trained to care for people safely.

We saw that an order had already been placed for new sheets. We saw mugs being used by people and we were told by the manager that a recent order had been made and this was ongoing as needed.

Due to the complexities of people's illnesses, none of the people at the home were able to express their views about their life at the home. Observation was used to assess the wellbeing and happiness of people. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care used to understand experiences of people unable to talk with us. We spent forty minutes closely observing five people. We also sat with people whilst they were eating lunch and observed the interaction between staff and people living at the home.

Mrs Oaten is no longer managing the home. A new manager was appointed a year ago, and has recently applied to be registered as manager with CQC.

We had received concerns that people were not able to leave their rooms when they wished to. We saw that bedroom doors had 'hotel' type locks on them, which prevented people entering the room without a key. People inside the rooms could leave when they chose.

People’s care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare.

During our inspection we heard staff speaking with people in a respectful and caring way. People appeared relaxed and comfortable in their interactions with staff.

The new manager told us that no-one living at the home could express their views formally. They told us that staff ensured people's needs were met by ensuring they received individual attention.

We inspected the home over two days to follow up on our last inspection carried out in November 2013. On that inspection we identified concerns in relation to the way that people were asked to give their consent to care and treatment, care and welfare, management of medicines, supporting workers and assessing and managing the quality of the service. Following the inspection the provider sent us an action plan telling us what action they were going to take to improve.

On this inspection we checked to see what actions they had taken. We saw that improvements had been made.

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 caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

This is a summary of what we found:

Is the service safe?

CQC monitors the operation of the Deprivation of Liberty safeguards which applies to care homes. The provider had taken advice on the Deprivation of Liberty safeguards to ensure they did not apply to one person living at the home and had found they did not need to make an application for authorisation and the person was not being illegally detained.

We saw that risk assessments were completed and updated to reflect the care needs of people at the home, the environment and for safe working practices. These along with the controls associated with them helped to reduce the risks to people living at or working in the home. Policies and procedures had also been updated.

The systems for the management of medication had improved and were being regularly audited. This helped to ensure people received the correct medication at a time they needed it.

Is the service effective?

We saw people’s needs were assessed and addressed well. Staff knew the people they were caring for and understood how they liked their care to be delivered. We saw that people’s healthcare needs were assessed and action plans put in place where needed to ensure people’s health needs were addressed.

We spent time on the inspection observing people’s care and experiences of the home. We saw people were supported well by staff and this was supported by relatives who told us “The staff are excellent. I know XXXX is very well cared for and I visit every day.”

We saw people being supported by staff who were confident and competent in the interactions we witnessed. We saw staff used moving and handling equipment successfully and supported people who were agitated effectively.

On our last inspection of the home we had identified concerns over the ways in which people were asked or not asked to consent to care and treatment. On this inspection we saw that this had improved. Staff had been trained in the Mental Capacity Act 2005 which is legislation that supports people’s rights to make decisions while they can do so, and ensured people's capacity to make decisions for themselves was being assessed correctly. This meant that the home was ensuring people were having decisions made that were in their best interests.

Staff training had improved and was co-ordinated better. This helped to ensure staff were equipped and supported to provide care for people.

Is the service caring?

We saw that people were spoken to respectfully by the staff. We saw care being delivered by staff in a timely way with patience and understanding. Staff we spoke with understood the impact of dementia on people’s lives, and on how this affected their whole family. We saw that relatives were encouraged to visit the home and support people with their care. We saw relatives helping people to eat and to follow activities of their choice. They told us how much comfort it gave both parties to maintain this level of involvement.

We saw that people’s individuality and personal style were respected and celebrated respectfully by staff. Staff spoke about people respectfully and with compassion during handovers and in the office and service areas.

Is the service responsive?

We saw that the home had made changes to the environment to meet people’s needs for information to support them with their dementia. This included signs to show the location of toilets and communal areas to help people orientate themselves.

We found the service had responded to people’s assessed needs. For example one person had identified in their plan they enjoyed birds. The home had built an aviary in an enclosed courtyard so that this person could be encouraged to take an interest and play a role in the care of the birds.

We saw training courses had been provided to support staff in their roles. This included an advanced dementia course, conflict resolution and care of pressure areas.

Is the service well led?

We saw that changes were being made to the registration of the home. The care manager was making an application to be registered as the person in day to day charge of the home. Staff we spoke with spoke highly of the home’s management and were clear about lines of authority.

The manager had developed the quality assurance systems in place since the last inspection including the increase in internal audits being undertaken. We saw that the home responded to comments and suggestions from relatives or supporters and staff meetings were held where staff members could communicate with management. We saw senior staff confidently allocating tasks to individuals and transferring information to make sure that important points of care did not get forgotten.

Relatives expressed confidence in the standards of the home and the quality of care their relative’s received. One told us "I have worked with the staff so they know how xxx likes things done”.

The provider confirmed that an application had been submitted to remove a regulated activity as it was not appropriate for the service. This had been inappropriately applied for at the time of registration. An application had also been made to register the care manager as the registered manager of the home. This will reflect the position of her being in day to day charge of the home.