About the service:

Hooklands Care Home provides accommodation with personal care for people over age of 65. The service is registered to accommodate up to 27 people, and was providing personal care to 23 people at the time of the inspection. Any nursing needs were provided by community nursing services.

People’s experience of using this service:

• The service had made improvements since our last inspection. Whilst the provider had progressed quality assurance systems to review the support and care provided, there was a need to further embed and develop some areas of the quality assurance system which had missed the areas of improvement we found.

• Risk assessment’s varied in completeness and there was a lack of guidance for staff to manage assessed risks. Staff were knowledgeable about people's needs and people’s safety had not been impacted.

• People and relatives told us they were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

• Records to demonstrate how assessments and decisions had been taken varied in completeness.

• People told us and we observed that they were safe and well cared for and their independence was encouraged and maintained. Comments included, "It’s a very nice place”, “Staff are very kind” and "It's lovely here."

• People received care and support that was safe. The provider followed safe recruitment processes which ensured people were suitable for the job they were applying for and staff were of good character. All staff had received training in safeguarding vulnerable people.

• There were sufficient staff to support people with their daily living and activities.

• People received effective care and support. Staff demonstrated a clear understanding of people's needs and received training relevant to their role.

• People enjoyed a healthy balanced and nutritious diet based on their preferences and health needs.

• People received care from staff who were kind and caring. Staff respected people's privacy and dignity always. People were supported to express an opinion about the care provided and the day to day running of the service.

• People received responsive care and support which was personalised to their individual needs and promoted independence. There was guidance for staff on how to support people in line with their personal wishes, likes and dislikes. People were supported to access health care services and professionals when necessary.

• Records showed the service responded to concerns and complaints and learnt from the issues raised.

• The management team demonstrated an open and positive approach to learning and development. People told us that they felt the management team were open to suggestions, approachable and that the service was well led.

• The management team worked professionally with agencies outside of the service and ensured a transparent, honest approach to their work which was valued by others.

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

Rating at last inspection:

Since Hooklands Care Home was registered in March 2016, we have carried out three comprehensive inspections and one focused inspection at this service. On all four occasions, the service has been rated as 'Requires Improvement', with repeated issues highlighted as concerns and any improvements not always being sustained. We have taken this into account when considering the overall rating. An overall rating of 'Good', cannot be awarded when there is a breach of Regulation.

At the last inspection in October 2018 the service was rated Requires Improvement (report published on 16 November 2018). At that inspection we found the provider to be fully compliant with the Regulations, but were rated as Requires Improvement for the key questions, is the service safe and well led? The provider needed to demonstrate they could sustain

We previously conducted a comprehensive inspection of Hooklands Care Home on 8 January 2018. After that inspection we received concerns in relation to the safety of people at the service regarding safeguarding practices. Social services and the provider had told us about a safeguarding concern that we needed to gather further information about to assure ourselves that people were safe.

As a result of these concerns we undertook an unannounced focused inspection of Hooklands Care Home on 12 October 2018 to look into those concerns. This report only covers our findings in relation to the ‘Safe’ and ‘Well-led’ key questions. The remaining two key questions of ‘Safe’ and ‘Well-led’ were rated as ‘Requires improvement’ at our last inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hooklands Care Home on our website at www.cqc.org.uk.

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. We previously inspected the service on 8 January 2018 with the key questions of ‘Effective’, ‘Caring’ and ‘Responsive’ were all rated as ‘Good.’ The remaining two key questions of ‘Safe’ and ‘Well-led’ were rated as ‘Requires improvement’ at our last inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Hooklands care home on our website at www.cqc.org.uk.

Hooklands Care Home 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. Hooklands care home accommodates up to 27 people in one adapted building. People who lived at the service require personal care and may be living with dementia or other long-term conditions. The home is situated on the coast in Bracklesham Bay. The back garden leads directly onto the beach behind, with sea views from the lounges, dining area and some bedrooms of the service. There is a lift to access bedrooms on the first and second floors. At the time of our inspection 23 people lived at the home.

There was 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.

Safe:

Systems and processes safeguarded people from abuse and people told us they felt safe and were happy at Hooklands Care Home. However, we found that a new member of care staff who did not have previous knowledge or experience of working in the social care sector had not received a robust induction or training in relation to safeguarding. The provider and registered manager were in the process of reviewing the induction process at the time of this inspection. Other staff understood how to identify and raise safeguarding concerns appropriately.

We have made a recommendation about recruitment and induction processes for new staff.

People, care staff and health care professionals stated that there may not always be enough staff to meet the complex and person-centred needs of all people who lived at the service.

People received medicines safely but ‘As required’ (PRN) protocols and information for staff for when these medicines could be used for people required further detail and guidance, particularly when the PRN medicine was used for the management of behaviours that challenge. For example, while risks to people were assessed with actions for staff to take to reduce risks. People and staff were not always protected by practices that avoided the risks of physical harm to them. Whilst care and manag

Hooklands Care Home 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. Hooklands Care Home provides accommodation for up to 27 people who require personal care and may be living with dementia or other long term conditions. The home is situated on the coast in Bracklesham Bay. The back garden leads directly onto the beach behind, with sea views from the lounges, dining area and some bedrooms of the service. There is a lift to access bedrooms on the first and second floors. At the time of our inspection nine people were living at the home.

This was an unannounced inspection which took place on 8 January 2018.

At the last inspection conducted on the 14 and 17 August 2017, this service was rated as ‘Inadequate’ which placed it in ‘special measures’. Services in special measures are kept under review and if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

At the previous inspection we found five breaches. Three continued breaches in relation to, the safe care and treatment of people, lack of appropriate training or supervision for staff to suitably carry out their duties and a lack of systems and processes to effectively monitor the quality and safety of the service provided. Two new breaches were found in relation to the safeguarding of people and the cleanliness and suitability of the premises.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions ‘safe, effective, caring, responsive and well-led’ to at least ‘good’. We found that positive improvements had been made to all key questions during this inspection.

Since the last inspection, the provider applied to deregister the ‘nursing’ registration for the service, which means that only people with needs that can be met safely and appropriately in a residential care home can now be accommodated at Hooklands Care Home.

At the time of this inspection there was no registered manager in post. However, a new manager had been appointed who had been in place for three months. 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. The new manager was in the process of applying to become the registered manager for this service and we had received an application from them.

The new manager had introduced many positive changes since the last inspection. New staff had been appointed and a new call bell system had been installed by the provider. Medicines were stored and administered safely and people’s records were held confidentially in a locked room. We recommended that the manager ensured that medicines for people continued to be monitored closely to ensure improvements are embedded in practice. People were safeguarded from abuse. Staff had received training and the local social services department had lifted the contract ‘suspension’ with the service which enabled the home to admit new people to live there. New audits had been introduced which meant that the service was now effectively monitoring the quality and safety of the service provided to people. A consultant had also been appointed by the registered provider to support the new manager in their role. The consultant also completed audits to ensure an independent view was provided of the service. The manager was proactively wo

This was an unannounced inspection which took place on 14 August 2017 and 17 August 2017. The registered manager was given notice of the second date as we needed to spend time with her to discuss aspects of the inspection and to gather further information.

Hooklands Care Home with Nursing provides accommodation for up to 27 older people who require nursing or personal care and who may be living with dementia. The home is located in Bracklesham Bay and the garden backs onto the sea. Communal areas include two lounges and a dining area. There is a lift to access bedrooms on the first and second floors. At the time of our inspection 19 people were living at the home. Of these, 16 people required nursing care and 10 people were living with dementia.

During our inspection the registered manager was present. 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.

We previously inspected the home in January 2017,which was the first inspection since the home was purchased and registered to be operated by a new provider. At the January 2017 inspection five breaches of regulations were identified. These related to safe care and treatment as risks to people’s health and wellbeing were not being managed safely and staff were not being provided with sufficient training and support in order to provide safe and effective care. Also, recruitment practices were not robust as checks were not undertaken to ensure staff did not pose a risk to people. Mental capacity assessments had not been completed and applications had not been made to the authorising authority for people who were being deprived of their liberty. Quality monitoring systems were not in place and as a result shortfalls in service provision were not being identified and acted upon.

In response, the registered manager and provider sent us an action plan that detailed the steps that would be taken to achieve compliance. The home was rated ‘Requires Improvement’ in the Effective, Caring, Responsive and Well Led domains and ‘Inadequate’ in the safe domain. An overall rating of ‘Requires Improvement’ was awarded.

At this inspection we found that improvements had taken place with regards to recruitment practices and consent to care. However, insufficient action had been taken and a further deterioration had taken place in relation to safe care and treatment, staff training and support, and, good governance. Also, new concerns were identified in relation to the environment, safeguarding, staffing levels and statutory notifications and breaches of regulations were identified in these areas. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

There was no equipment such as sensory devices available in the home to alert staff if people fell and needed assistance. Referrals to external professionals had not been made when people fell to ensure action was taken to minimise the risk of further falls. Risk assessments and care plans were either not in place or incomplete for people who were at risk of choking. Skin and wound care management was not always robust. There was a lack of information about risks associated with choking and the provision of pureed meals meant that staff unfamiliar with the needs of people might give people meals that placed them at risk of harm. Medicine records were not complete and as a result could not be used to establish if people had received medicines as prescribed.

We identified multiple safeguarding concerns that placed the majority of people who lived at the h

The inspection took place on 24 and 26 January 2017 and was unannounced.

Hooklands Care Home with Nursing provides accommodation for up to 27 older people who require nursing or personal care. At the time of our visit, there were 20 people in residence. The service is located in Bracklesham Bay and the garden backs onto the sea. Communal areas include two lounges and a dining area. There is a lift to access bedrooms on the first and second floors. The new provider was investing in the service and had made improvements to the fabric of the home and garden. Adaptations were also planned to make the home environment more suited to people living with dementia.

The service did not have a registered manager. A new manager had been appointed in October 2016 and was in the process of registering with us. 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, relatives and staff spoke highly of the service and the kindness of the staff team. We found, however, that there were no systems in place to monitor the quality and delivery of the service in order to ensure that people received safe care.

The service was not safe. People were at risk of receiving inappropriate care or treatment because risks to their health, safety and welfare had not been assessed or managed consistently.

There was no system in place to ensure that medicines were managed safely and the competency of staff administering medicines had not been checked.

New staff had started working in the home before the necessary recruitment checks had been completed.

The service was not always effective. Some staff had not received necessary training to enable them to provide effective support to people. Although staff felt supported, they had not received recent supervision or an appraisal of their performance.

Where people lacked capacity to make decisions relating to their care and treatment, staff did not understand or put into practice the requirements of the Mental Capacity Act 2005 (MCA). This meant that people’s wishes and rights may have been overlooked.

People were not fully involved in planning and reviewing their care. There was limited information about their future wishes and no evidence of their involvement when significant changes occurred. We have made a recommendation about involving people to ensure their care is appropriate and reflects their needs and preferences.

The service was not always responsive. People’s care plans did not always reflect their current needs and monitoring records about their care were incomplete. Although staff knew people well, there was no system to ensure staff would identify or know how to respond to changes in a person’s health.

People felt confident to raise any concerns with staff and told us they knew how to complain. Following our inspection, the provider updated their complaints policy to ensure that clear information was displayed and available to people.

The service was not consistently well-led. The manager and provider knew the service needed to improve but there was no system to identify areas of concern or a clear plan of action as to how and when known issues would be addressed.

Due to our concerns, we shared our findings with the local authority safeguarding team and the West Sussex Fire and Rescue Service.

People told us the staff were caring. There was a regular team of staff at the home, which helped to provide continuity for people. In one card of thanks we read, ‘Thank you all for looking after me so beautifully. It was the happiest place to be when I needed the extra nursing care’. In the provider’s survey one response read, ‘The staff are more like friends and family than carer, nothing is too much tr