CQC report explained · a nursing home
What the CQC found at Hatton Court Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Inspectors found that risks were identified but were not always managed properly. They also found shortfalls in fluid monitoring, pressure sore care, medicines records, staffing, infection control and the use of masks.
- Effective?
- Good
- This question was not inspected during this focused visit. Its previous rating was used in calculating the overall rating.
- Caring?
- Good
- This question was not inspected during this focused visit. Its previous rating was used in calculating the overall rating.
- Responsive?
- Good
- This question was not inspected during this focused visit. Its previous rating was used in calculating the overall rating.
- Well-led?
- Requires improvement
- Inspectors found that governance systems had not been used effectively. Care records were not always accurate or up to date, repeated problems had not been resolved, and agency staff were not always properly supervised.
What inspectors found, October 2021
Rated Requires Improvement; inspectors found risks to people's care and weak oversight, although staff were caring and improvement work had started.
This was an unannounced focused inspection on 5 and 10 August 2021. Inspectors spoke with people, visitors, staff and health professionals. They observed care and reviewed care, medicine, staffing and management records.
The home was not always safe. Risk plans and records were incomplete, fluid monitoring was inconsistent, and pressure sore care had not always followed professional advice. There were also concerns about staffing levels, medicines records, equipment cleaning and staff use of masks.
The home was not well-led. Audits had not fixed repeated problems with care records and daily charts, and agency staff were not always properly overseen. The manager had left, and an operations manager was providing day-to-day cover.
The overall rating changed from Good to Requires Improvement. Only Safe and Well-led were inspected at this visit. The ratings for Effective, Caring and Responsive were carried over from the previous comprehensive inspection.
Caring staff
Inspectors saw staff treating people with respect, dignity and compassion. Some relatives also praised the support given with video calls.
“Staff were attentive to people's needs and we saw positive, caring interactions between them.” from the report
Safe recruitment
Recruitment records were up to date and the required checks had been completed before new staff started.
“The provider followed safe recruitment practices to ensure staff were suitable to work with people at the home.” from the report
Premises safety checks
The home carried out regular checks on the building, equipment, fire safety and utilities. Emergency evacuation plans were in place for each person.
“The provider completed regular checks on the home environment to ensure it was safe for people who lived there.” from the report
COVID-19 testing and visits
Visitors were tested before entering, and the home supported testing and vaccination for people and staff. Inspectors were assured about several visitor and infection control arrangements.
“Arrangements were in place for visitors to be tested for COVID-19 prior to entering the home, this included health professionals.” from the report
Risks were not consistently managed
seriousSome people did not have clear plans for falls or choking risks. Repositioning and fluid monitoring did not always follow what people needed, increasing the risk of harm.
“The action needed to reduce these risks did not always happen.” from the report
Pressure sore care and reporting
seriousA professional recommendation to reposition one person more often had not been updated in the records. A pressure wound had also not been reported as required.
“This placed the person at increased risk of further skin deterioration.” from the report
Poor records and oversight
seriousCare plans, catheter plans, fluid charts and repositioning charts were not always accurate or complete. The home's audits had identified some problems, but they continued.
“The provider's own audits showed a history of daily charts, such as fluid intake and repositioning charts, not always being completed by staff.” from the report
Staffing pressure
needs fixingPermanent staffing levels were lower than usual and the home relied on agency staff. Staff were often focused on tasks and had less time for person-centred care.
“Staff were mostly focussed on completing tasks and responding to people's immediate needs, rather than being able to spend quality time with people.” from the report
Medicine recording and storage
needs fixingTwo people ran out of medicine without a clear written explanation. An out-of-date prescribed cream was also found in a communal bathroom.
“We found two instances of people running out of medicine.” from the report
Infection control practice
needs fixingSome staff did not wear masks correctly, and moving and handling equipment was not always cleaned between uses. Inspectors said this could increase the risk of cross infection.
“The provider had not ensured staff wore their PPE correctly and equipment was cleaned between uses.” from the report
- 01What has changed since the inspection to make sure falls, choking, fluid intake and repositioning risks are recorded and acted on?
- 02How do you now monitor pressure sores, and how are professional recommendations passed promptly into care plans and daily records?
- 03What are the current permanent staffing levels, and how are agency staff checked, supervised and deployed?
- 04How do you check that medicines are available, in date and fully recorded when problems occur?
- 05What action has been taken to improve communication with relatives and keep them informed about injuries, treatment changes and weight loss?
This was a focused inspection of Safe and Well-led only; the ratings for Effective, Caring and Responsive were carried over from the previous comprehensive inspection. This explanation was written from the published report of 21 October 2021 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, July 2018
Rated Good; inspectors found safe, kind and responsive care, with some staffing and record-keeping points to monitor.
This was an unannounced inspection on 7 and 8 June 2018. Two inspectors and an expert by experience spoke with people living in the home, relatives, staff and health professionals. They observed care and checked care records, medicines records, risk assessments, staff files, training records and quality checks.
The home was rated Good overall and Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. People told inspectors they felt safe, staff were kind, medicines were managed safely, and people received suitable food and healthcare.
The inspection found improvements since January 2017, when the home was rated Requires Improvement. People living with dementia were now being given the same opportunities as others. A new management team was in place, and inspectors found better systems for checking quality and acting on concerns.
Kind and respectful care
Inspectors saw staff explain what they were doing, work at a person's pace and check that the person was comfortable. People said staff respected their privacy and choices.
“People were cared for by staff who were kind and attentive to their care and support needs.” from the report
Safe medicines and risk management
Medicines were stored, given and recorded safely. Risk assessments covered areas such as mobility and skin damage, and accidents and near misses were reviewed.
“Medicines were managed safely and people received their prescribed treatment as directed by the prescriber.” from the report
Activities suited to individuals
The home adapted activities for people's needs, including offering a book club in a person's bedroom and using memory boxes and pictorial information for people living with dementia.
“This demonstrated that staff had taken the time to find suitable social activities with regards to people's specific needs.” from the report
Improved management
The new management team was described as approachable. People and staff were involved in decisions, and the home used audits and action plans to drive improvements.
“The provider had effective governance in place to assess, monitor and to drive improvements.” from the report
Vacant staff hours
minorThe manager reported 216 vacant staff hours each week, including nursing and care hours. These were covered by existing staff and agency staff, and inspectors did not find an impact on people during the visit.
“The registered manager told us there were 216 vacant staff hours per week.” from the report
Mental capacity knowledge
minorNot all staff spoken with had a clear understanding of the Mental Capacity Act. Most staff did understand the importance of helping people make their own decisions.
“Although not all the staff we spoke with had a clear understanding of the MCA most were aware of the importance of enabling people to make their own decision.” from the report
- 01How are the 216 vacant staff hours currently covered, and how do you check that agency or existing staff are not overstretched?
- 02How do you make sure every staff member understands the Mental Capacity Act and supports people to make their own decisions?
- 03Do all current improvement plans include a named person and a date for completion?
- 04How are activities adapted for people living with dementia, sensory impairments or limited mobility?
- 05How are complaints and concerns recorded, reviewed and followed up with families?
This was an unannounced inspection of the overall service, covering all five CQC questions, with observations, interviews and checks of care, medicines, staffing and quality records. This explanation was written from the published report of 20 July 2018 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Hatton Court Care Home
4 rated inspections over 6 years: the service has slipped, from Good to Requires improvement.
- October 2021Requires improvementcurrent ratingdown from GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- July 2018Goodup from Requires improvementSafe: GoodWell-led: Good
- March 2017Requires improvementdown from GoodSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- August 2015GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- July 2014
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 21 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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