Hunters Down is registered to provide accommodation and nursing care for up to 102 people. At the time of our inspection there were 96 people living at the service. The service is a two storey premises located on the outskirts of Huntingdon. The service has communal lounges and dining areas on each floor and all bedrooms are single rooms with an en-suite toilet and washbasin. The service is split into five units known as Montague, Pepys, Cromwell, Kings and Queens. People are cared for in a unit according to their needs and levels of independence.

This unannounced comprehensive inspection was undertaken by two inspectors and an expert by experience and took place on 5 June 2017. At the previous inspection on 23 June 2015 the service was rated as ‘Good’. At this inspection we found the service remained 'Good'.

A registered manager was in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Staff had a good understanding of how to protect people from harm. This was as well as being knowledgeable about those organisations they could report any potential concerns to.

Accidents and incidents such as falls, were identified and acted upon when required.

Risks of harm to people such as choking, malnutrition and skin integrity had been assessed and were managed well.

There were enough competent staff to provide people with support when they needed it.

Staff had received appropriate training, support and development to carry out their role effectively.

People received appropriate support to maintain healthy nutrition and hydration. Staff enabled people to access support from external health care professionals as soon as this was required.

Shortfalls in staff practice around medicines administration had been successfully implemented to address the accurate recording of medicines.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLs). People 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.

People we observed were treated with kindness by staff. However, not all staff were consistent in their approach to respecting people's privacy and dignity. Not all people's needs were responded to in a person centred way.

People were given the opportunity to feed back on the service and their views were acted on.

People received personal and nursing care by staff who provided this care with compassion and kindness.

People were offered and took an active part in the varied hobbies, interests and pastimes that were provided.

The registered manager and their team worked hard to create an open, transparent and inclusive atmosphere within the service. People, staff and external health professionals were invited to take part in discussions around shaping the future of the service.

There was a robust quality assurance system in place and shortfalls identified were promptly acted on to improve the service.

Further information is in the detailed findings below.

Hunters Down Care Centre is located on the outskirts of the town of Huntingdon. The home provides accommodation for up to 102 people who require nursing or personal care. At the time of our inspection there were 90 people living at the home. Accommodation is provided over two floors and all bedrooms are single rooms with en suite facilities. There are five units, Queens, Cromwell, Montague, Kings and Pepys. People are accommodated in different units according to their needs

This unannounced inspection took place on 23 June 2015.

At our previous inspection on 15 July 2014 the provider was in breach of one of the regulations that we assessed. This was with regarding to people’s care and welfare. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach. During this inspection we found that the necessary improvements had been made.

The home had a registered manager in post. They had been registered since July 2013. 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 provider ensured that only suitable staff were offered employment at the service. This was through a robust recruitment process. There was a sufficient number of suitably experienced staff. An induction process was in place to support and develop new staff.

Staff were trained in medicines administration and had their competence regularly assessed to ensure they adhered to safe practice. However, the provider’s policy in respect of the recording of medication was not always being followed by staff in some areas of the home. Staff had been trained in protecting people from harm and had a good understanding of what protecting people from harm meant.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The registered manager and staff were knowledgeable about when a request through the Supervisory Body (Local Authority) for a DoLS would be required. Applications to lawfully deprive people of their liberty had been correctly submitted by the registered manager. Staff were very knowledgeable about when and what action to take if this was required. People’s ability to make decisions based on their best interests had been clearly documented to demonstrate the specific choices people could make decisions about.

People’s care was provided by staff who always respected their privacy and dignity. People were provided with care that was compassionate, caring and supportive of their choices and preferences.

People’s care records were kept up-to-date by staff. This was to help ensure the information staff required to meet people’s needs was clear and easy to follow. People were involved as much as possible in their care planning and were supported by relatives or friends. An independent advocacy service was provided to those people when this was necessary.

People were supported to access a range of health care professionals including community nurses or their GP. Prompt action was taken in response to the people’s changing health care needs. Risks to people’s health were managed in response to each person’s assessed risks and needs. Health care professional advice was followed and adhered to by staff.

People were supported to have sufficient quantities of the food and drinks that they preferred and staff encouraged people to eat healthily. People were supported with a diet which was appropriate for their needs including soft food diets to ensure they remained safe with their eating and drinking.

Information, guidance and advice was provided to people, family members or their relatives on how to raise a concern or make compliments. Staff knew how to respond to any reported concerns or suggestions. Effective action was taken to address people’s concerns and to reduce the risk of any potential recurrence.

The provider and registered manager had audits and quality assurance processes and procedures in place. Staff were supported to develop their skills, increase their knowledge and obtain additional care related qualifications. Information gathered and analysed was used to drive improvement in the service provided.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection. This meant that the provider and staff did not know when we were inspecting the service.

At our previous inspection in September 2013 the provider was not in breach of any of the standards we looked at.

Hunters Down Care Centre provides a service for up to 102 people who have care and nursing care needs including those living with dementia. There were 83 people living at the home when we visited. The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Policies and procedures were in place in relation to the MCA and DoLS to ensure that people who could make decisions for themselves were protected. Applications for DoLS had been appropriately sought and authorised.

Staff respected people’s privacy and dignity. Staff, people and relatives we spoke with had concerns that there was insufficient staff to safely meet people’s care needs. People had to sometimes wait for care including assistance with going to the toilet. People were not always supported with their wellbeing in a timely manner.

People’s health care needs were assessed and care was planned. However, this was not always delivered in a consistent way. From the nine people’s plans of care we looked at we found that the information and guidance provided to staff was detailed and clear. Health risk assessments had been completed which helped ensure that they were not exposed to any unnecessary risks whilst also being supported to take risks where this was safe to do so.

Records we looked at and people we spoke with demonstrated to us that the social and daily activities that were provided were based upon people’s known likes and dislikes. The provider was aware that some people’s life history information was limited to basic personal and family details and they were taking action to address this.

Staff responded appropriately if people were unhappy about something. People were supported to complain or raise any concerns if they needed to using the forms that were provided or by speaking with staff. We were provided with positive comments about the service from healthcare professionals.

The provider had a robust recruitment process in place. Staff were only employed at the home after all essential checks had been satisfactorily completed. Staff’s knowledge about safeguarding and its reporting procedures demonstrated to us that if any abuse was identified that this would be reported to the appropriate authorities without delay.

The provider used a variety of ways to assess the quality of service that it provided including audits such as, ‘quality of life’ audits, involving people and families, and others on a regular basis. However, we found that where actions had been taken these had not always been effective.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to the care and welfare of people who use services. You can see what action we told the provider to take at the back of the full version of this report.

One person said: “The staff spoil me. They make sure I’m all right all the time”. One relative said: “It’s a top home. They have a lot of patience with my (relative)”.

One member of staff said: “I can’t fault the home. The procedures work better and the information is recorded”.

We saw that the units we visited and the bathrooms and toilets we inspected were clean and fresh. There were no malodours. Some carpets were stained in the lounge areas of some units. One person said: “It’s a very good place. They come and clean (the bedroom and en suite) every day”.

We noted that some people had ill-fitting shoes which could cause them to fall. We spoke with the manager and staff who said they requested that family members provide appropriate footwear but this was sometimes not provided. The manager stated she would check that all shoes and slippers were suitable.

One person told us, "I quite like it here. Everyone is very kind." Another person told us, "It's a wonderful place. There's everything you want here." One person who was due to go home said, " If I go home I shall miss being here....the staff are so helpful and pleasant. I may find I can’t cope at home and if I can’t I won’t worry about coming back here.”

Some people said they thought there was a shortage of staff and two people said they felt hurried when staff assisted them with their personal care that morning. The manager stated there were no staff vacancies at the time of the inspection. We found that staff were busy in the home but people were assisted in a calm atmosphere. We noted that people were clean and well dressed.

Staff we spoke with knew the people they were caring for and how to ensure the care provided was personalised to enable people remained as independent as possible. We saw different communication methods used when people had difficulties understanding speech.

Overall the home was clean with no offensive odour. There was one unit that was malodorous but later in the day this had been dealt with. Some units had carpets that were in need of cleaning, although spot cleaning was undertaken during the inspection. Generally the decor was good and each unit had different pictures for example. People had their own possessions in their rooms, having things such as a TV, pictures, radio and telephone.

People we spoke with were complimentary about the care and accommodation provided in the home. People stated that they were very satisfied with the meals provided and advised that drinks and snacks were also available throughout the day.

Relatives that we met were positive about the home and felt that their relative was well cared for and that they could confidently raise any issues or concerns with the manager and staff team.