CQC report explained · a nursing home
What the CQC found at The Hamlets
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risk assessments, medicines management, staffing and infection control had improved. However, inspectors still gave limited assurance about safety, and one unlocked sluice room door had to be put right during the inspection.
- Effective?
- Requires improvement
- Staff training, supervision, consent arrangements and support with food and healthcare had improved. The rating remained Requires Improvement because care and support did not always achieve good outcomes or were inconsistent.
- Caring?
- Requires improvement
- This question was not inspected during this focused visit. The report says ratings for questions not inspected used ratings from the last inspection, but it does not give a Caring rating in this report.
- Responsive?
- Good
- Care plans were more personalised and people were supported with meaningful activities, communication and complaints. One missing food chart was identified and corrected straight away.
- Well-led?
- Requires improvement
- New audits and governance processes had started and people, relatives and staff described improvements. Inspectors said management and leadership were still inconsistent and the new systems needed to become established.
What inspectors found, September 2023
Rated Requires Improvement; inspectors found major progress since the previous Inadequate rating, but safety, effectiveness and leadership still need work.
This was an unannounced focused inspection on 27 July, 3 August and 14 August 2023. Two inspectors spoke with a resident, relatives, managers and staff. They observed care and reviewed care records, medicines, recruitment files and management records.
The home had improved since the last inspection. Risk assessments and care records were more detailed, medicines were managed safely, staffing had improved and the home was cleaner. People said they felt safe and liked the staff. Responsive care was rated Good.
The overall rating changed from Inadequate to Requires Improvement. Safe, Effective and Well-led were each rated Requires Improvement. The home was no longer in breach of the regulations identified at the previous inspection and was removed from Special Measures, but inspectors said there was still limited assurance about safety and inconsistent leadership.
Improved risk management
Risk assessments and care records reflected people's current needs and gave staff enough detail to support them safely. Choking risks from specialised diets were also being managed.
“People were no longer exposed to risk of harm because their risk assessments and records were reflective of their current needs and contained sufficient detail to help guide staff with how to support them safely.” from the report
Staffing and recruitment
Inspectors found enough staff to support people safely. Recruitment checks were completed before staff started work.
“People we spoke with and staff told us there was enough of them and this had improved since the last inspection.” from the report
Personalised activities and care
People were supported with activities that mattered to them. Staff were observed having kind and caring interactions with residents.
“People were supported to undertake activities which were meaningful for them, and we observed kind and caring interactions between staff and people who lived at the home.” from the report
Improved openness and feedback
The provider had begun displaying audit information and holding meetings with people and families. Inspectors saw evidence that feedback had been acted on.
“Regular meetings had begun to be held with people and family members to enable them to share their views about the service.” from the report
Safety assurance still limited
seriousAlthough safety had improved, inspectors said some aspects were not always safe and there was still an increased risk that people could be harmed.
“This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.” from the report
Some monitoring was incomplete
needs fixingOne person with diet-controlled diabetes needed food intake monitoring but did not have a food chart. Staff corrected this during the inspection.
“We did see one person who required their food intake monitoring due to having diet controlled diabetes, they did not have a food chart.” from the report
Refurbishment was still needed
minorSome bedrooms still needed decoration. A refurbishment programme for communal areas had been agreed but was due to take place soon.
“The provider had recently arranged for a refurbishment programme to take place in the home. This was because some parts of the home required redecoration.” from the report
Leadership systems not fully established
needs fixingNew governance systems and audits had started, but inspectors said leadership and management remained inconsistent.
“This meant the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.” from the report
- 01What progress has been made with the refurbishment programme, and which bedrooms or communal areas still need work?
- 02How do you check that the new risk assessments and care records remain up to date for each resident?
- 03How do you make sure food and drink monitoring is completed for people who need it, including people with diabetes or swallowing risks?
- 04What audits are now carried out, how often are they reviewed, and what action is taken when problems are found?
- 05How will you show that the home has maintained the improvements since it left Special Measures?
This was a focused inspection of Safe, Effective, Responsive and Well-led; Caring was not inspected, and the report says ratings for questions not inspected use ratings from the previous inspection. This explanation was written from the published report of 12 September 2023 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, January 2023
Rated Inadequate and placed in special measures; inspectors found serious safety, care and leadership problems.
Inspectors visited without notice on 9 and 11 November 2022. They spoke with people living in the home, visitors and staff, observed care, and reviewed care, medicine, recruitment and management records.
They found people were exposed to avoidable risks. Records and risk assessments were incomplete, medicines were not always managed safely, and incidents were not properly recorded or reviewed. Some staff lacked training for people's mental health and learning disability needs.
People said they liked living in the home and liked the staff. However, inspectors saw some care that was not dignified or person-centred. The home was rated Inadequate overall, with Safe, Effective and Well-led rated Inadequate, and Caring and Responsive rated Requires Improvement.
The provider acted immediately on some risks raised during the inspection and sent an action plan. The home was placed in special measures, meaning CQC will monitor it and normally re-inspect within six months.
Staffing levels
Inspectors found enough staff were deployed to meet people's needs. Recruitment checks were also completed safely.
“Observations showed there were enough staff deployed to meet people's needs.” from the report
Food and drink choices
People were supported to choose their food and were offered drinks and snacks during the day.
“People were supported to eat and drink food of their choice.” from the report
Action after inspection
The provider acted quickly on some risks raised on the first day and put updated information and mitigation processes in place.
“When we returned on day 2, we saw the provider had responded immediately by updating their documentation and putting mitigation processes in place.” from the report
Unsafe medicines
seriousMedicines were left unattended, one medicine was picked up from the floor and given to a person, and covert medicines were not managed safely.
“On day 1 of our inspection, we observed medication was left unattended on top of the medication trolley.” from the report
Incomplete risk information
seriousRisk assessments did not give staff enough guidance about choking, diabetes, epilepsy and behaviour-related risks. Some furniture and toilet fittings were also unsafe.
“Some risk assessment were not in place and some risks where not robustly assessed in order to keep people safe from harm.” from the report
Poor management oversight
seriousAudits did not identify important shortfalls, and incidents and accidents were not routinely analysed. This meant the provider could miss opportunities to prevent harm.
“The provider failed to ensure there were effective governance and quality assurance measures in place.” from the report
Insufficient specialist training
seriousStaff had not received specific training to support people with learning disabilities and mental health needs. This meant inspectors could not be assured that staff would always respond appropriately.
“Regular and agency staff had not received specific training to be able to support people with learning disabilities and those with mental health needs.” from the report
Consent and best interests
seriousRecords did not consistently explain people's decision-making abilities. Best-interest records were missing for some decisions, including some DNACPR and covert medicine decisions.
“We were not assured the service was always acting in people's best interest.” from the report
- 01What has changed since the inspection to make medicines, including covert medicines, safe?
- 02How are choking, diabetes, epilepsy and behaviour-related risks now assessed and reviewed?
- 03What specialist training have staff completed for mental health needs and learning disabilities?
- 04How are best-interest decisions and consent now recorded, including for DNACPR decisions and covert medicines?
- 05What audits now check incidents, care plans, medicines and the condition of the home?
The inspection was prompted by concerns about staffing and culture and first focused on Safe and Well-led, but it was widened to include Effective, Caring and Responsive; infection prevention and control was also examined under Safe. This explanation was written from the published report of 17 January 2023 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 The Hamlets
4 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- September 2023Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: Requires improvementResponsive: GoodWell-led: Requires improvement
- January 2023InadequateSafe: InadequateEffective: InadequateResponsive: Requires improvementWell-led: Inadequate
- May 2021Inspected but not ratedSafe: Inspected but not ratedWell-led: Inspected but not rated
- January 2021Inspected but not ratedSafe: Inspected but not rated
- July 2019Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- November 2016GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- January 2014
Report published without a new overall rating.
- June 2013
Registered with the Care Quality Commission on 20 June 2013.
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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