About the service:

Hurst Nursing Home is a care home with nursing and is registered to provide accommodation and support for a maximum of 22 people. At the time of the inspection there were 19 people living at the service with one additional person admitted during the day. At certain times of the year the service also had two beds reserved by the local health authority to relieve winter pressures on hospital services.

People living at the service were mainly older people, some living with long term health conditions or memory loss, although the service was not a specialist dementia care home.

People’s experience of using this service:

People and their relatives spoke well of the service they received from Hurst Nursing Home. People’s needs, and wishes were met by staff who knew them well.

The service placed people’s wellbeing at the heart of their work. People received personalised support which met their needs and preferences wherever possible. People said the service listened to their wishes and suggestions to improve their care and support.

We identified some areas of the building that could potentially present risks to people, such as low windows with period glass, wardrobes not fixed to walls and a low bannister rail. Immediately after the inspection the registered manager sent us evidence these had been risk assessed and actions taken.

People received their medicines as prescribed. We identified some risks associated with long term health conditions were not being assessed, but this was addressed immediately following the inspection. Other risks around people’s care or health were assessed and managed, for example for falls or pressure ulcers. We have made a recommendation in relation to the service seeking a review and updating of forms used by medical professionals to record actions to be taken in the event of a sudden deterioration in people’s health.

Systems were in place to safeguard people from abuse, and the service responded to any concerns or complaints about people’s wellbeing. We saw good practice in relation to equality and diversity, and on the reviewing of the effectiveness of pain relief.

There was a thorough recruitment process in place that checked potential staff were safe to work with people who may be vulnerable. Enough staff were in place to meet people’s needs, and staff received the training and support they needed to carry out their role.

There was established leadership at the service. Effective quality assurance systems were in place to assess, monitor and improve the quality and safety of the service provided. Systems ensured learning took place from incidents and accidents, and information about best practice was used to inform improvements in care.

More information is in the full report

Rating at last inspection: This service was last inspected in September 2016, when it was rated as good in all areas and as an overall rating.

Why we inspected: This inspection was scheduled for follow up based on the last report rating.

Follow up: We will continue to monitor the intelligence we receive about the service. If any concerning information is received, we may inspect sooner.

This inspection took place on 30 and 31 August 2016 and was unannounced.

Hurst Nursing Home is a nursing home registered for up to 22 older people. At the time of this inspection there were 16 people accommodated, 12 of whom lived with dementia.

A registered manager was in post when we visited. 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. The registered manager was present during our visit.

The registered manager had been appointed since our last visit. They were able to demonstrate the steps they had taken to make the necessary improvements that were identified at the last inspection. At the previous inspection in October 2015 we identified breaches of Regulation related to person-centred care and treatment, consent to care and treatment, safe care and treatment, good governance and staffing. The service was previously rated “Requires Improvement” overall. We required the service to make improvements to these areas and they sent us an action plan of how this would be achieved. At this inspection we found that previous Regulations that had been in breach were now being complied with and the overall rating for the service had improved.

The registered manager and staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring, if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm.

Staff recognised the signs to look for if they suspected abuse had taken place; they knew how to report any incidents of abuse they may witness. Any potential risks to individual people had been identified and appropriately managed. People’s medicines had been administered and managed safely.

There were sufficient numbers of staff on duty with the necessary skills and experience to meet people’s needs. Staff were clear about their roles and felt well supported in their work.

Staff supported people to eat and drink if required. They ensured people at potential risk received adequate nutrition and hydration. People were provided with support to access health care services in order to meet their needs.

Positive, caring relationships had been developed with staff to ensure people received the support they needed. They were encouraged to express their views and to be actively involved in making decisions about the support they received to maintain the lifestyle they have chosen. A relative, who spoke for their family member as well, said, “We would both recommend Hurst Nursing Home. (Family member) is quite happy here.”

The culture of the service was open, transparent and supportive. People and their relatives were encouraged to express their views and make suggestions so they may be used by the provider to make improvements. One person told us, “I can guarantee this place is absolutely wonderful!”

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

On the day of our inspection there were 19 people living at the home. People told us that although staff were busy they were satisfied with their care. By observing care and looking at records we saw that people were given choices in their care, they were safe and their dignity and privacy were respected.

We spoke with four members of staff. One new member of staff explained that they had received enough training and support to do their job well.

We spoke with five people who use the service, of which three were able to communicate their experiences of the service to us. They told us that they "enjoyed the food" and that "nothing was too much trouble" for the chef.

We spoke with one relative who said that they had received support from staff to help maintain their spouse's mobility.

We used a number of methods to help us understand the experiences of people using the service, because some people using the service had complex needs which meant they were not able to tell us their experiences. We observed staff interacting and communicating effectively with people. We saw people undertaking activities and displaying pleasure in them.

Records showed that people had been supported and encouraged to make decisions about their lives. We inspected care records that showed people or their representatives were asked for their consent.

Staff spoken with showed understanding of how to safeguard people from harm. Training records showed that staff received training. We found there were enough experienced and trained staff available to support people.

We saw records showing the provider assessed and monitored the quality of the service. We saw that people were asked their views about the home in surveys and actions from these. We saw audits and action plans that showed that the home was responding to people, their relatives and to staff.

People told us that they felt safe in the home and the quality of care was good. We were told that people got the help that they needed and we observed staff responding quickly to people's requests.

We were in receipt of information from relatives and a safeguarding investigation in which neglect was substantiated. West Sussex County Council has completed their investigation but has requested a health review of the case from the Local Community NHS Trust. That review is not as yet complete but the health professional spoken to shared concerns that had been identified to date.

People spoken to on the day of the visit and their relatives were very happy with the care stating that staff are kind and respectful and always ready to listen.

Hurst Nursing Home provides nursing care and accommodation for up to 22 older people. At the time of this inspection, there were 18 people living at the home, all of whom required nursing care and nine were living with different stages of dementia.

A registered manager was in post when we visited. 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.

All of the people and relatives we spoke with during the inspection said they felt safe in the home. One person told us, “I absolutely feel safe; there is no funny stuff going on in here”.

We saw staff deliver care with compassion and understanding. They took time to listen to people to ensure they understood them. Staff were seen to be positively and meaningfully interacting with people. There appeared to be a good rapport between staff, people and their relatives.

Staff we spoke with knew how to keep people safe; they were able to identify signs of possible abuse and knew what to do if they witnessed them. However, not all staff had received up to date training in this area.

Staffing levels provided were sufficient to meet the needs of people accommodated.

People and their relatives said that the food at the home was good and choices had been provided. Where necessary, people were given help to eat their meal safely and with dignity.

Care records indicated risk assessments had been carried out, for example with regard to skin integrity, nutrition and hydration. However, records of nursing care and treatment provided were not up to date or complete. This meant that identified risks to people may not be effectively managed to reduce the likelihood of occurrence or recurrence.

Care plans were in place for all but one person who had recently been admitted. However, people, or their relatives, had not been consulted with regard to their needs and wishes to ensure the care provided was person centred. Information had not been kept up to date to ensure it reflected people’s current needs. Care plans were not effective in making sure people’s needs had been met.

A limited programme of activities had been provided. However, it was not clear how they provided for the needs of people who stayed in their rooms. This meant that they were at risk of isolation and withdrawal.

Not all staff had received supervision and appraisals at regular intervals to ensure they had the necessary skills and knowledge required to carry out their work. Staff training records indicated training had not been kept up to date and some staff had received no training at all in some essential areas, such as understanding dementia and diabetes.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes are called the Deprivation of Liberty Safeguards (DoLS). It is the responsibility of the Commission to monitor how the MCA and DoLS are applied in health and care services it has registered.

Despite having some training in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS), the registered manager and staff demonstrated a limited understanding of their role and responsibilities in this. Where people did not have the capacity to make decisions about their care, the registered manager was unable to demonstrate how this was assessed and how decisions would be made. DoLS applications had been made on behalf of seven people even though there was no evidence to demonstrate they lacked capacity.

People and their relatives had been asked for their views of the quality of the service. However, the registered manager was unable to demonstrate how comments and suggestions received had been considered and, where appropriate, action implemented to improve the service.

A quality assurance system was in place to monitor how the service had been provided and to identify shortfalls. This did not include monitoring complaints, accidents, incidents or safeguarding referrals so that lessons could be learned and action taken to reduce the likelihood of recurrence. There was no evidence to demonstrate, where shortfalls had been identified, action had been taken to make improvements to the service.

We have identified several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told this provider to take at the back of this report.