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Inspection Summary


Overall summary & rating

Good

Updated 7 December 2016

This comprehensive inspection took place on 10 November 2016 and was unannounced. The inspection team consisted of two adult social care inspectors. Home of Comfort Nursing Home is registered to provide accommodation, support and nursing care for up to 30 people. At the time of the inspection, there were 27 people living at the home.

At the last inspection on 23 December 2013 we found the service to be compliant with all regulations we assessed at that time.

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.

People living at the home said they felt safe. The visiting relatives we spoke with also said they felt their family members were safe as a result of the care provided.

We looked at four staff personnel files and there was evidence of robust recruitment procedures in place.

Staffing levels were sufficient on the day of the inspection to meet the needs of the people who used the service. Staff told us they felt staffing numbers at the home were sufficient. People living at the home also said they felt there were enough staff working at the home and did not have to wait long periods for assistance.

There was an up to date safeguarding policy in place, which referenced legislation and local protocols. The staff we spoke with had a good understanding of safeguarding, abuse and how they would report concerns.

We saw people had risk assessments in their care plans in relation to areas including falls, pressure sores, and malnutrition.

Accidents and incidents were recorded correctly and included a record of the accident or incident, a summary chart and action plan.

The home was adequately maintained and we saw evidence recorded for the servicing and maintenance of equipment used within the home to ensure it was safe to use. Comprehensive records were in place and up to date regarding the safe upkeep of the premises.

Monthly infection control audits were in place and included areas such as furniture, bedrooms and the general environment and equipment. Personal protective equipment (such as gloves and aprons) were available throughout the home. Cleaning schedules were in place and up to date. The premises were clean throughout and free from any malodours.

There was an up to date a fire policy and procedure. Fire safety and fire risk assessments were in place and fire evacuation drills were carried out regularly and staff attendance recorded to ensure all staff undertook regular drills.

We observed staff administering medicines and saw that people were given their medicines as required. Staff who administered medicines had all completed appropriate training in the safe handling of medicines. Records of medicines administration (MAR’s) had been completed consistently and accurately.

People had medication care plans in place which included their photograph to assist staff with accuracy of administration, GP details, details of currently prescribed medicines, if a specific eating regime was in place such as a soft diet, daily nutritional intake charts, and a MAR chart. There were safe systems for ordering, receiving, storage, administration and disposal of medicines.

People told us they felt staff had the sufficient skills, knowledge and training to care for them effectively.

Staff told us they received an induction when they first started working at the home which gave them a good introduction to working in a care environment.

Comprehensive staff training records were in place and staff had completed training in a variety of other areas relative to their job role The staff we spoke with said they received sufficient training to help them undertake their role effectively.

There was a staff supervision schedule and annual appraisal schedule in place, which identified meetings during the year.

We checked whether the service was working within the principles of the MCA and whether any conditions on authorisations to deprive a person of their liberty were being met. We found that the service was complying with the conditions applied to the authorisations. Staff demonstrated a good understanding of MCA/DoLS and told us about when they felt a DoLS authorisation might be required.

Staff were aware of how to seek consent from people before providing care or support and told us they would always ask before providing care. People living at the home told us staff always sought their consent before delivering care to them.

People we spoke with told us the food provided at the home was of a good quality. People had nutritional care plans in place and care plans also contained records of visits by other health professionals. Special diets were catered for, food allergies were recorded and people had nutrition and hydration care plans in place.

There were some adaptions to the environment, which included pictorial signs on some doors which would assist people living with a dementia.

Staff showed patience and encouragement when supporting people. We observed people were treated with kindness and dignity during the inspection. Care staff spoke with people in a respectful manner.

The people we spoke with told us they received good care whilst living at Home of Comfort and described the staff as kind and caring. People said they felt treated with dignity, respect and were given privacy at times they needed it. Staff were also able to describe how they aimed to treat people in this manner when delivering care, telling us it was extremely important. We saw that the care staff knocked on people’s bedroom doors and waited for a response before entering.

Throughout the course of the inspection we heard lots of chatter and laughter between staff and people and there was a positive atmosphere within the home. People said staff tried to promote their independence when delivering care and allow them to try and still do things for themselves.

People’s care files contained end of life care plans, which documented people’s wishes at this stage of life where they had been open to discussing this. Staff told us they involved families when developing care plans or carrying out assessments.

People living at the home told us they received a service that was responsive to their needs. We saw the home had been responsive in referring people to other services when there were concerns about their health.

When people first started living at the Home of Comfort, an initial assessment was undertaken. This enabled staff to establish what people’s care needs were and the type of individual care people required.

The care plans provided an overview of people’s care needs following their initial assessment and any actions staff needed to complete and follow in order to meet their needs. The care plans we looked at were reviewed each month, or if there was a change to people’s care needs. Care plans were also audited each month by the manager to ensure consistency and quality of recording.

The home had systems in place to seek feedback from people living at the home. This included sending a satisfaction survey which had recently been sent in September 2016.

We looked at the minutes from the most recent residents and relatives meeting. This presented people with the opportunity to discuss the care they received and inform staff about any concerns or things they might like to change within the home.

There was a system in place to handle and respond to complaints. We saw the home had an appropriate policy and procedure in place, which informed people of the steps they could take if they were unhappy with the service they received.

The home had received a high number of compliments from people who had previously used the service and their relatives.

We looked at the activities available at the home and also how people were stimulated throughout the day. The home employed an activities co-ordinator. Each person had an individual activities record and a therapeutic activity plan assessment. Each person’s expressed likes and dislikes regarding activities were also recorded in their files.

People living at the home said they knew the manager and thought highly of them and the care staff. There was a clear management structure at the home which was a registered charity. There was a board of trustees who oversaw the running of the home and all income generated was re-invested into the home and used for care delivery purposes and day to day running.

The staff we spoke with told us they enjoyed working at the home and that there was an open transparent culture. Staff also told us leadership and management at the home was strong. Staff described feeling able to approach the manager, report concerns and also felt supported to undertake their roles to the best of their ability.

The registered manager undertook regular audits covering areas such as information and involvement, personalised care/treatment, the dining experience, safeguarding, staffing/training and the environment.

We found that residents’ meetings had been held regularly. Records of these meetings were detailed and showed that various issues had been discussed.

The registered manager held a CQC notifications file, understood their role in sending notifications to CQC and had sent us notifications as required by the regulations.

Staff had access to a wide range of policies and procedures.

The service had a business continuity plan that was recently reviewed in May 2016.

Inspection areas

Safe

Good

Updated 7 December 2016

The service was safe.

Staffing levels were sufficient on the day of the inspection to meet the needs of the people who used the service and there was evidence of robust recruitment procedures.

People we spoke with who lived at Home of Comfort told us they felt safe.

Records of medicines administration had been completed consistently and accurately. Accidents and incidents were recorded correctly including a record of the accident or incident.

Effective

Good

Updated 7 December 2016

The service was effective.

Staff were subject to a formal induction process and probationary period and there was a staff supervision schedule in place.

The service was complying with the conditions applied to DoLS authorisations.

Staff were aware of how to seek consent from people before providing care or support. People’s care plans contained records of visits by other health professionals.

Caring

Good

Updated 7 December 2016

The service was caring.

Staff spoken to had a good understanding of how to ensure dignity and respect and staff showed patience and encouragement when supporting people.

We heard lots of laughter between staff and people and there was a positive atmosphere within the home.

The service involved people and their families when developing care plans

Responsive

Good

Updated 7 December 2016

The service was responsive.

Care files were well organised and contained information that covered a range of health and social care support needs.

Each person had a detailed care pathway, an assessment of possible risks and a description of the person’s needs for support and treatment.

The home had procedures in place to receive and respond to complaints.

Well-led

Good

Updated 7 December 2016

The service was well-led.

Staff told us they enjoyed their work and that there was a good culture at the home.

We found there were appropriate systems in place to monitor the quality of service.

Team meetings took place, giving staff the opportunity to discuss their work and raise concerns.