This inspection was unannounced and took place on 7 and 8 June 2018.

Hatton Court Care Home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Hatton Court Care Home accommodates 60 older people some of whom were living with dementia. The provider also offered nursing care. On the days of our inspection 57 people were living in the home. The home is situated on one floor and was accessible to wheelchair users.

The home had a registered manager who was present on both days of our 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 2008 and associated Regulations about how the service is run.

At the previous inspection in January 2017, the service was rated Requires Improvement. We found that people living with dementia did not have the same opportunities as others. Although the former registered manager was aware of this, they had not taken any action to ensure people living with dementia were treated fairly. At this inspection the new registered manager told us that the unit where people living with dementia resided had closed and had recently reopened as a reablement unit. The provider continued to offer a service to people living with dementia. We found that these people were now treated equally and were offered the same opportunities as others and had access to various stimulating social activities.

Since our last inspection visit the provider had appointed a new management team. People knew who the new registered manager was and found them approachable and told us they were happy with the management of the home. The provider had effective governance in place to assess, monitor and to drive improvements. People and staff were given the opportunity to be involved in the running of the home. People were supported to maintain links with their local community and the involvement of outside agencies assisted with promoting people’s wellbeing.

People could be confident that their complaints would be listened to, taken seriously and acted on. The registered manager informed us that no one in the home was currently receiving end of life care.

People told us they felt safe living in the home and staff were aware of their responsibilities of safeguarding people from potential abuse. The risk to people was assessed and action was taken to minimise the risk of harm. People were cared for and supported by sufficient numbers of staff who had been recruited safely. Appropriate systems and practices were in place to ensure the safe management of medicines. Staff practices made sure people were protected from the risk of avoidable infections. Incidents, accidents and nears misses were reviewed and action taken to reduce the risk of a recurrence.

The assessment of people's care, support and treatment needs were carried out to ensure they received the appropriate support. People were cared for by staff who were skilled and supported in their role. People were complimentary about the meals provided and staff were aware of people’s food preferences with regards to their health condition, religion, likes and dislikes. Access to relevant healthcare services promoted people's physical and mental health.

The environment was conducive to people's needs and they had access to relevant aids and adaptations to promote their independence. People were encouraged to make their own decisions and staff were aware of the importance of obtaining their consent before delivering care and support.

People were cared for by staff who were kind and attentive to their needs. People’s involvement

This inspection was unannounced and took place on 8 and 9 January 2017.

Hatton Court Care Home provides accommodation and personal care for up to 60 older people and also provides a service for people living with dementia. On the day of our inspection there were 43 people living there.

The home had a registered manager who was present on the second day of the inspection. 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.

Prior to this inspection we had received information of concern by people who wish to remain anonymous. They alleged there were insufficient staffing levels provided to meet people’s needs especially during the weekend. Hence, the first day of this inspection was carried out on Sunday. People told us staff were available to support them when needed. People told us they felt safe living in the home and staff knew how to protect them from the risk of potential abuse. People were protected from the risk of harm because staff were aware of safe practices to reduce the risk of accidents. People were supported by skilled staff to take their prescribed medicines.

People living with dementia did not have the same opportunities as other people who lived in the home. People’s involvement in their care assessment ensured they received a service that met their preference. People could be confident their complaints would be listened to and acted on.

People had the opportunity to have a say in how the home was run and were supported to maintain contact with their local community. People received care and treatment from staff who were supported by the registered manager and nurses. The provider had systems in place to review and monitor the quality of service provided to people. However, these systems did not identify the difference in the quality of service provided to people living with dementia.

People were supported by skilled staff who received regular one to one [supervision] sessions. People could be assured their human rights would be protected because staff adapted the principles of the Mental Capacity Act 2015 in their work practice. People were provided with a choice of meals and had access to drinks at all times. People were supported by staff to access relevant healthcare services when needed.

People were supported and cared for by staff who were kind and compassionate and care was provided in a way that promoted their privacy and dignity. People’s involvement in their care planning ensured they received a service that was specific to their needs.

This inspection took place on 2 June 2015 and was unannounced.

Hatton Court Care Home is registered to provide accommodation with nursing and personal care for a maximum of 60 people. On the day of our inspection 58 people were living at the home.

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.

People told us they felt safe living at home. Staff knew how to protect people and report incidents of concern. People's medicines were managed safely and staff followed the organisation's guidance in administration, storage and disposal of people's medicines.

At the time of the inspection people were not supported by sufficient staff numbers. However, following the inspection these have been reviewed and increased on Ellerdine unit. Staff received appropriate training, support and supervision. There was a recruitment procedure in place which was followed. This ensured staff were appropriately checked before they started work at the home.

We saw evidence of mental capacity assessments for people that lacked capacity with the exception of one person.

Health care professionals were accessed for people when they needed them. People were supported to maintain independence and control over their lives by staff who treated them with dignity and respect.

A menu was produced which provide a range of choices and special diets were catered for. A variety of group and social activities were available for people to choose from.

The registered provider had a complaints policy which was available to everyone. Complaints were managed and in line with the policy. Systems were in place to regularly audit the quality of the service and the manager acted where audits identified improvements were required.

The provider had appointed an acting manager who was running the service and had made application to CQC. They are referred to as “the manager” throughout this report. They had begun to implement changes to improve the home and drive continuous improvement.

As part of this inspection we spoke with eight people who used the service and two visiting relatives. We spoke with the manager who told us they were due to complete their probationary period in a couple of weeks. They told us that on successful completion of their probationary period they would be sending the necessary paperwork to CQC to apply to become the registered manager. We spoke with two nurses a housekeeper and two care staff. We also reviewed records relating to the management of the home and staff which included four personnel records and four care plans. We observed interactions between people and the staff.

Below is a summary of what we found. The summary describes what people using the service, and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were treated with respect and dignity by the staff. Care plans were in the process of being developed to contain more person centred information. The new style care plans were clearer. They identified people’s needs and were reviewed regularly. Staff demonstrated a good understanding of people’s needs. People were given choices and supported to make decisions themselves. Individual risk assessments were in place for things such as moving and handling and trips and falls. Control measures were identified. This meant that people’s needs were met and people were kept safe. People we spoke with confirmed they felt safe living at the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Documented procedures were in place for The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and how to submit one. We saw records of recent DoLS applications. This was as a result of new guidance issued by the courts. This meant that systems were in place to safeguard people as required.

The service was safe, clean and hygienic. Vacant rooms were being redecorated and new carpet was waiting to be fitted. However, the dementia unit at the service was in need of redecoration. Curtains in the communal lounge area looked untidy and in need of a clean. People we spoke with told us their rooms were cleaned daily. One person said, “The laundry is wonderful.” Another person told us they had moved rooms because of an odour. Their old room was currently vacant and was awaiting new carpet to be fitted. This meant that the provider took action to maintain a clean hygienic environment and reduce the risk of spread of infection.

Recruitment practice was safe and thorough. Disciplinary procedures had been used where necessary. This was to ensure people’s safety was maintained. Professional registrations were maintained. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. One person said, “I’m quite happy here, most staff are very good.” Another person said, “The girls have been exceptional, very good.”

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints and concerns. People had access to a copy of the complaints procedure. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People experienced care and support that met their needs. People were supported to participate in activities. Some people told us they preferred their own company but were asked if they would to participate in activities. One person said, “We are going on a trip to a garden centre.” Some people told us they were involved in changes to their care. One person said, “They always contact my relative if there are any concerns.” This meant that people were involved in decisions about their care.

People who were able to could move around the home freely and safely. Regular audits and checks took place. Issues identified were acted on. This meant the service had effective systems in place to identify improvements and continually meet people’s needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that support workers showed patience and gave encouragement when supporting people. We saw people responded positively to staff. One person said, “Most staff are caring.” Another person said, “Staff give me choices, they know I would ask if I needed help.” Another person said, “Staff ask what I want help with.” People were very positive about the staff and the care they received.

People’s preferences, likes, dislikes and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes. People were involved in their day to day care and were supported to maintain relationships that were important to them. Religious services were available to people who wanted to participate. This meant people’s diversity and individuality were promoted and respected.

Is the service responsive?

We saw staff that responded quickly to meet people’s needs and ensured people’s safety and dignity was maintained. For example, staff responded quickly reassure a person who was becoming distressed. We saw that people were supported to express their views and these were acted on. People had the opportunity to engage in activities both within the home and local community.

People we spoke with were aware of how to make a complaint. We spoke with a relative who had previously made a complaint. They told us they had been informed of their right to make a complaint to CQC. They said, “I don’t think you can fault the care.”

Is the service well-led?

On completion of a probationary period the current manager would be applying to become the registered manger. Staff told us that the provider invested in and supported the home and staff. This was for things such as new flooring, redecoration, new food trolley and thermo flasks. The service worked well with other agencies and services to make sure people received their care in a joined up way. All staff felt supported in their roles and felt their views were listened to. Staff we spoke with told us they were happy working at the home.

The service had a quality assurance system. A number of audits were undertaken monthly and annually. Action was taken as a result of audit findings. This meant the quality of the service was continually improving.

There were forty eight people living in the home on the day we visited, and twelve of these people were being supported with needs relating to their dementia conditions. We met and spoke with over half of the people who lived at the home. We spoke with four relatives, including relatives of some people who were not able to share their views with us. We also spoke with seven members of staff including the registered manger.

Everyone agreed they were happy to be living at the home and were satisfied with the care and support they received. People told us that their privacy and dignity was always promoted and respected. Our observations supported this and we saw numerous examples of good care.

People's needs were comprehensively assessed and care and treatment was planned and delivered in line with their individual care plan. People told us that their medical, personal and emotional care needs were met. They said they were supported by a knowledgeable and well trained staff team who knew people's care and support needs well.

Hatton Court had comprehensive quality monitoring tools in use to ensure that they maintained good quality and safe care. We saw they effectively sought people's views about their care and listened to them.

We carried out this review to check on the care and welfare of people using this service.

There were 52 people living in the home when we visited the service. We met and spoke with 17 people who lived at the home, 13 relatives, including four people who were visiting, and eight members of staff. We looked at selected care records, staff files and other records relating to the running of a care home.

We were informed 12 people who lived at the home had a dementia related illness.

We therefore undertook a short observational framework (SOFI) which is a tool used by the Commission to assess the quality of care when people may not be able to give their views on the place where they lived or the care they received.

People we spoke with told us they were happy living at home.

Everyone we spoke with said that they had been consulted and involved in their care and treatment. People said that their needs and wishes were identified and staff supported them in ways that they preferred.

After our inspection we contacted relatives of the people who were not able to share their views with us. They agreed they were satisfied with the care their family member received at the home.

People told us that their privacy and dignity was always promoted and respected. Our observations supported this and we saw numerous examples of good care.

We saw people enjoyed a wide range of activities and therapies. People told us that there was always something to do and that they always looked forward to visiting.

People’s needs were comprehensively assessed and care and treatment was planned and delivered in line with their individual care plan. People told us that their medical, personal and emotional care needs were met. Relatives told us that people received excellent care and support from a staff team. One person told us. “I have complete confidence in Hatton Court”.

People told us that they felt safe and risk assessments demonstrated how risks were identified and reduced as far as possible. Risks were regularly reviewed and people were enabled to be as independent as they were able. Staff were aware of risks, people’s rights and their responsibilities in order to enable people to do this.

People told us they were pleased with the cleanliness of Hatton Court. They commented the new carpeting provided in most of the communal areas had made a big difference to keep the home smart and clean. One regular visitor to the home commented “it is always spotlessly clean”.

People were supported by a knowledgeable and well trained staff team who knew people’s care and support needs well. Staff were offered staff a range of training opportunities that were specifically designed to meet the needs of the people that they supported. People were protected because staff were confident to recognise and report abuse.

Hatton Court had systems in place to seek the views and opinions of people who received a service. Staff told us that the service was patient led.

Hatton Court had comprehensive quality monitoring tools in use to ensure that they maintained good quality and safe care. They effectively sought people’s views about their care and listened to them.